Lung Cancer Surgery: Thoracoscopic Lobectomy And Wound Infection Rates
Overview
This meta-analysis rigorously examines the impact of thoracoscopic lobectomy on wound infection rates and complications among lung cancer patients. Through a comprehensive search across multiple databases, including PubMed, Embase, and Cochrane Library, among others, this study identified 21 relevant studies encompassing 2,118 patients undergoing lung cancer surgery. The analysis demonstrates that thoracoscopic lobectomy yields significant benefits, notably reducing the incidence of wound infections (OR = 0.22, 95% CI: 0.13–0.37, p < 0.001) and overall complications (OR = 0.27, 95% CI: 0.21–0.36, p < 0.001) compared to conventional open thoracotomy. Furthermore, thoracoscopic lobectomy is associated with shorter hospital stays (standardized mean difference = -2.07, 95% CI: -2.39 to -1.76, p < 0.001), indicating enhanced efficiency and recovery. These findings underscore the therapeutic efficacy of thoracoscopic lobectomy in lung cancer treatment, advocating for its wider adoption in clinical practice.
Introduction
In 2020, lung cancer accounted for approximately 1.8 million deaths worldwide, making it the leading cause of cancer-related mortality. Early diagnosis of lung cancer poses a significant challenge as symptoms often manifest only in advanced stages, leading to delayed treatment initiation. Surgical intervention remains the primary treatment modality for lung cancer patients. While traditional thoracotomy offers thorough tumor removal, it comes with drawbacks such as compromised chest wall integrity, impaired respiratory function, and substantial physical and psychological trauma to patients.
Video-assisted thoracoscopic lobectomy has emerged as a preferred alternative in recent years. This minimally invasive approach reduces incision length, lowers pulmonary surgery complications, stabilizes patients more rapidly post-surgery, and yields improved therapeutic outcomes. Recognized for its ability to enhance patient quality of life, video-assisted thoracoscopic lobectomy has gained widespread acceptance among medical professionals and patients alike.
To further validate the efficacy of thoracoscopic lobectomy and provide robust evidence for its clinical application in lung cancer treatment, this study undertakes a meta-analysis. By comparing the impact of thoracoscopic lobectomy versus conventional thoracotomy on wound infection rates and postoperative complications in lung cancer patients, the study aims to inform clinical practice and optimize patient care.
Method
A comprehensive search strategy was employed to identify relevant studies comparing thoracoscopic lobectomy with traditional thoracotomy in lung cancer treatment. Various databases, including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang, were searched from inception to September 2023 using specific keywords related to lung cancer and surgical procedures.
Inclusion criteria encompassed studies involving lung cancer surgery patients, with the experimental group undergoing thoracoscopic lobectomy and the control group receiving traditional thoracotomy. Key outcomes of interest included wound infection, complications, and hospital stay. Eligible studies comprised randomized controlled trials or observational studies, while exclusion criteria comprised duplicate publications, articles lacking relevant raw data, incomplete or inaccessible full-text data, reviews, case reports, systematic evaluations, conference articles, and animal studies.
Following literature retrieval, duplicates were removed using EndNote X9, and two researchers independently screened titles, abstracts, and full texts based on the inclusion and exclusion criteria. Any discrepancies were resolved through discussion or with the assistance of a third researcher. Data extraction, including author information, publication year, sample size, demographics, and outcome measures, was conducted using Excel.
To assess the quality of nonrandomized control studies, the Newcastle-Ottawa Scale (NOS) was utilized, evaluating three dimensions and eight items. A high-quality study was indicated by a total of 9 stars, while ≤4 stars suggested low quality and ≥7 stars indicated high quality, aiding in the evaluation of study validity and reliability.
Statistical Analysis
The data analysis was conducted using Stata 17.0 software. Dichotomous variables were presented as odds ratios (OR) with 95% confidence intervals (CI), while continuous variables were expressed as standardized mean differences (SMD) with 95% CI. Heterogeneity was evaluated using the χ2 test and I2 values. A fixed-effect model was applied in cases where I2 was less than 50% and p was greater than 0.1, indicating minimal heterogeneity; otherwise, a random-effect model was utilized. Sensitivity analysis was performed to ensure the robustness of the study findings. Additionally, when more than 10 studies were included, a funnel plot was employed to assess publication bias, ensuring the reliability and validity of the research outcomes.
Result
The literature screening process involved a comprehensive review of 571 articles initially identified. Through careful examination, 263 duplicate articles were manually removed, ensuring the integrity of the dataset. Subsequently, the remaining 308 unique articles underwent further scrutiny, with their titles and abstracts screened to determine relevance to the study objectives. A total of 186 articles were excluded at this stage due to their lack of alignment with the research focus.
Following this initial screening phase, the full texts of the remaining 122 articles were meticulously reviewed to assess their suitability for inclusion in the study. From this detailed evaluation, 21 studies were deemed pertinent, collectively comprising data from 2118 patients who had undergone lung cancer surgery. These studies were selected based on their relevance to the investigation of wound infection, complications, and hospital stay duration in lung cancer surgery patients.
The selected studies provided valuable insights into the outcomes of lung cancer surgery, with 1063 patients constituting the experimental group and 1055 patients forming the control group. By aggregating data from these diverse studies, the analysis aimed to elucidate trends and patterns in postoperative outcomes among lung cancer patients.
In the context of wound infection, the analysis revealed compelling findings. Among the 21 studies examined, 19 reported cases of wound infection, allowing for a thorough assessment of infection rates in both the experimental and control groups. The statistical analysis, conducted using a fixed-effect model, demonstrated a significantly lower infection rate in the experimental group compared to the control group. This noteworthy outcome underscores the potential benefits of the intervention under investigation in mitigating the risk of postoperative complications such as wound infections.
Similarly, the analysis of complications yielded significant insights into the comparative outcomes between the experimental and control groups. By synthesizing data from the included studies, the analysis revealed a substantially lower rate of complications in the experimental group, further substantiating the efficacy of the intervention in improving patient outcomes following lung cancer surgery.
Furthermore, the examination of hospital stay duration provided valuable insights into the recovery trajectories of lung cancer surgery patients. Despite significant heterogeneity noted across the included studies, the analysis demonstrated a consistent trend towards shorter hospital stays in the experimental group compared to the control group. This finding underscores the potential of the intervention to expedite patient recovery and reduce healthcare resource utilization.
To ensure the robustness of the study conclusions, sensitivity analysis was conducted to assess the stability of the findings. The results of this analysis affirmed the reliability of the study conclusions, providing confidence in the validity of the reported outcomes.
Moreover, the absence of publication bias, as evidenced by symmetrically distributed funnel plots, further enhances the credibility of the study findings. This suggests that the observed effects are unlikely to be influenced by selective reporting or publication-related biases, thus bolstering the overall robustness of the study.
In summary, the comprehensive analysis of the included literature sheds light on the impact of the experimental intervention on key postoperative outcomes in lung cancer surgery patients. By synthesizing data from a diverse array of studies, this analysis offers valuable insights into the efficacy of the intervention in reducing wound infections, complications, and hospital stay duration, thereby contributing to the optimization of patient care in the context of lung cancer surgery.
Conclusion
The latest ‘2023 Cancer Statistics Report’ from the American Cancer Society underscores lung cancer as the foremost cause of cancer-related deaths, claiming approximately 350 lives daily, a staggering figure nearly 2.5 times higher than the second-leading cause, colorectal cancer. Non-small-cell lung cancer (NSCLC) constitutes the predominant pathological type, encompassing around 87% of all lung cancer cases. Traditionally, thoracotomy lobectomy has been a standard surgical approach for lung cancer treatment, aiming to excise lesions and lymph nodes while preserving healthy lung tissue. However, this method imposes substantial trauma on patients, leading to prolonged postoperative recovery, and imposing dual economic and psychological burdens, particularly among older patients with compromised immunity.
In recent years, thoracoscopic surgery has emerged as a minimally invasive alternative for thoracic surgeries, including lung cancer treatment, offering potential advantages in terms of reduced trauma and enhanced recovery. Wound infection remains a primary concern post-thoracoscopic lobectomy, as it can impede wound healing and elevate the risk of systemic infections, thereby impacting patients’ physical and psychological well-being. Nonetheless, numerous studies attest to the lower risk of postoperative infection associated with thoracoscopic lobectomy compared to thoracotomy.
Common postoperative complications like pulmonary infection, atelectasis, and bleeding can exacerbate psychological stress, leading to delayed recovery and prolonged hospital stays. Notably, research indicates that thoracoscopic lobectomy is linked to lower complication rates and shorter hospital stays, attributed to factors such as smaller incisions, reduced intraoperative blood loss, and precise lesion exposure under endoscopic control. These advantages contribute to faster postoperative recovery and fewer complications, affirming the superior clinical efficacy of thoracoscopic lobectomy over thoracotomy in lung cancer treatment.
However, it’s important to acknowledge the limitations of this study, including small sample sizes in some studies, potential regional bias as all cases were from China, and the absence of research from other countries. Despite these limitations, the findings underscore the significant benefits of thoracoscopic lobectomy in reducing wound infections, complications, and hospital stays, highlighting its potential for broader clinical application in lung cancer treatment.
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