Abstract:

Objective

To evaluate the efficacy and safety of subxiphoid approach video-assisted thoracoscopic surgery(S-VATS) and Intercostal approach video-assisted thoracoscopic surgery(I-VATS)for mediastinal tumors .

Methods

All randomized controlled trial or controlled clinical trial about SVATS and I-VATS of mediastinal tumors were searched from PubMed , EMBASE ,ScienceDirect ,Cochrane Library ,China National Knowledge Infrastructure , Chinese Biomedical Literature Database ,Chinese Science and Technology Academic Journal and Wanfang (from establishment to March 2019) ,to assess operating time , intraoperative blood loss , volume of drainage after surgery ,duration of chest drainage , duration of postoperative analgesics ,duration of hospital stay ,pulmonary and cardiac complications .The quality of the inclusion studies was assessed according to the Cochrane Handbook for Systematic Reviews of Interventions Version 5 .1 .0 .The meta-analysis was conducted using RevMan5 .3 software .

Results

A total of 12 studies including 1 randomized controlled trials study and 11 case control studies , altogether involving 889 patients . Compared with I-VATS , S-VATS decreased significantly in intraoperative blood loss[MD(95% CI) : - 24 .54( -36 .99 , - 12 .09) , P＜0 .001] ,volume of drainage after surgery[MD(95% CI) :-209 .33( -292 .98 ,-125 .68) , P＜0 .001] ,duration of postoperative catheterization time [ MD ( 95% CI) : - 0 .91 ( - 1 .24 , - 0 .59) , P＜0 .001] ,postoperative complications[ OR(95% CI) :0 .36(0 .17 ,0 .74) ,P ＝0 .006] ,duration of postoperative analgesic intervention[MD(95% CI) :-1 .33( -1 .92 , -0 .75) , P＜0 .001] , and duration of hospital stay[MD(95% CI) : -2 .18( -3 .34 ,-1 .02) , P ＝ 0 .0002] . However , the relief of postoperative myasthenia gravis symptom [ OR(95% CI) :0 .48(0 .21 ,1 .06) , P＝0 .07] and operating time[MD(95%CI) :-5 .11( -23 .37 ,13 .15) , P ＝0 .58] were not significantly different .

Conclusions

The current evidence shows that S-VATS can reduce ,intraoperative blood loss ,volume of drainage after surgery ,duration of chest drainage ,duration of postoperative analgesics ,duration of hospital stay ,postoperative complications ,and would not increase postoperative myasthenia gravis symptom and operating time ,thus is a feasible and safe method in the treatment of mediastinal tumor .As the overall quality of enclosed literature is comparatively low , more reasonable , multiple-center and larger-sample RCT with higher quality would provide a higher level of evidence .

Key words: Video-assisted thoracoscopic surgery, Mediastinal tumors, Meta-analysis