Video-assisted Thoracoscopic Surgery versus Open Thoracotomy for Resection of Lung Metastasis—A Meta-analysis of Reconstructed Time-to-Event Data

Background: Lung metastases are frequently encountered in clinical practice, often necessitating surgical resection for optimal patient management. The ideal approach for metastasectomy, whether video-assisted thoracoscopic surgery (VATS) or open thoracotomy (OT), remains as an ongoing debate. We sought to conduct a systematic review and meta-analysis comparing VATS and OT in the context of pulmonary metastasectomy.

Methods: Three databases were assessed. The primary outcome was overall survival. The secondary outcomes were recurrence-free survival, ipsilateral recurrence, and hospital length of stay (LOS). Hazard ratios (HR), odds ratios (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated. Reconstruction of time-to-event data and sensitivity analyses were performed for the primary endpoint.

Results: After screening, 11 studies were included encompassing 2,159 patients undergoing lung metastasectomy (VATS: 827; OT: 1,332). Compared with OT, patients who underwent VATS had higher overall survival rates (HR 0.75; 95% CI 0.67–0.85; p < 0.01), no significant difference in recurrence-free survival (HR 1.07; 95% CI 0.88–1.29; p = 0.48), shorter hospital LOS (MD −1.99 days; 95% CI −2.59 to −1.39; p < 0.01), and no significant difference in ipsilateral recurrence rates (OR 0.86; 95% CI 0.52–1.42; p = 0.56).

Conclusion: For patients undergoing pulmonary metastasectomy, VATS strategy is associated with higher survival rates and shorter hospital LOS when compared with OT. Moreover, metastasis recurrence does not seem to be associated with long-term mortality in this population.

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Artikel online veröffentlicht:
11. Februar 2025