Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis
BackgroundAccumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.MethodsRelevant studies were retrieve...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-05-01
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| Series: | Frontiers in Surgery |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fsurg.2022.900414/full |
| _version_ | 1818269737545629696 |
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| author | Yuxiang Luo Feng He Qingchen Wu Haoming Shi Dan Chen Hongtao Tie |
| author_facet | Yuxiang Luo Feng He Qingchen Wu Haoming Shi Dan Chen Hongtao Tie |
| author_sort | Yuxiang Luo |
| collection | DOAJ |
| description | BackgroundAccumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.MethodsRelevant studies were retrieved by searching Embase and PubMed databases (from the inception to October 1, 2021). Primary outcomes included postoperative pain, intraoperative blood loss, operation time, chest tube duration, and hospital length of stay. All meta-analyses were performed by using random-effects models.ResultsOverall, 14 studies with 1,279 patients were included, with 504 patients undergoing anterior mediastinal surgery via subxiphoid approach and 775 via other approaches. The pooled results indicated that the subxiphoid approach was associated with reduced postoperative pain indicated by visual analog scale [weight mean difference (WMD): 24 h: −2.27, 95% CI, −2.88 to −1.65, p < 0.001; 48–72 h: −1.87, 95% CI, −2.53 to −1.20, p < 0.001; 7 days: −0.98, 95% CI, −1.35 to −0.61, p < 0.001], shortened duration of chest tube drainage (WMD: −0.56 days, 95% CI, −0.82 to −0.29, p < 0.001), shortened hospital length of stay (WMD: −1.46 days, 95% CI, −2.28 to −0.64, p < 0.001), and reduced intraoperative blood loss (WMD: −26.44 mL, 95% CI, −40.21 to −12.66, p < 0.001) by comparison with other approaches in anterior mediastinal surgery. Besides, it has no impact on operation time and the incidence of complications of transition to thoracotomy, postoperative pleural effusion, phrenic nerve palsy, and lung infection.ConclusionsOur study suggests that the subxiphoid approach is a feasible alternative approach and even can be a better option for anterior mediastinal surgery. Further, large-scale multicenter randomized controlled trials are needed to validate this finding. |
| first_indexed | 2024-12-12T20:59:08Z |
| format | Article |
| id | doaj.art-cf2e30a9a32949969686e526681faaaa |
| institution | Directory Open Access Journal |
| issn | 2296-875X |
| language | English |
| last_indexed | 2024-12-12T20:59:08Z |
| publishDate | 2022-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Surgery |
| spelling | doaj.art-cf2e30a9a32949969686e526681faaaa2022-12-22T00:12:13ZengFrontiers Media S.A.Frontiers in Surgery2296-875X2022-05-01910.3389/fsurg.2022.900414900414Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-AnalysisYuxiang Luo0Feng He1Qingchen Wu2Haoming Shi3Dan Chen4Hongtao Tie5Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Cardiothoracic Surgery, Fifth People’s Hospital of Chongqing, Chongqing, ChinaDepartment of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaDepartment of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, ChinaBackgroundAccumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.MethodsRelevant studies were retrieved by searching Embase and PubMed databases (from the inception to October 1, 2021). Primary outcomes included postoperative pain, intraoperative blood loss, operation time, chest tube duration, and hospital length of stay. All meta-analyses were performed by using random-effects models.ResultsOverall, 14 studies with 1,279 patients were included, with 504 patients undergoing anterior mediastinal surgery via subxiphoid approach and 775 via other approaches. The pooled results indicated that the subxiphoid approach was associated with reduced postoperative pain indicated by visual analog scale [weight mean difference (WMD): 24 h: −2.27, 95% CI, −2.88 to −1.65, p < 0.001; 48–72 h: −1.87, 95% CI, −2.53 to −1.20, p < 0.001; 7 days: −0.98, 95% CI, −1.35 to −0.61, p < 0.001], shortened duration of chest tube drainage (WMD: −0.56 days, 95% CI, −0.82 to −0.29, p < 0.001), shortened hospital length of stay (WMD: −1.46 days, 95% CI, −2.28 to −0.64, p < 0.001), and reduced intraoperative blood loss (WMD: −26.44 mL, 95% CI, −40.21 to −12.66, p < 0.001) by comparison with other approaches in anterior mediastinal surgery. Besides, it has no impact on operation time and the incidence of complications of transition to thoracotomy, postoperative pleural effusion, phrenic nerve palsy, and lung infection.ConclusionsOur study suggests that the subxiphoid approach is a feasible alternative approach and even can be a better option for anterior mediastinal surgery. Further, large-scale multicenter randomized controlled trials are needed to validate this finding.https://www.frontiersin.org/articles/10.3389/fsurg.2022.900414/fullsubxiphoid video-assisted thoracoscopic surgerysubxiphoid approachthymomameta-analysisanterior mediastinal surgery |
| spellingShingle | Yuxiang Luo Feng He Qingchen Wu Haoming Shi Dan Chen Hongtao Tie Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis Frontiers in Surgery subxiphoid video-assisted thoracoscopic surgery subxiphoid approach thymoma meta-analysis anterior mediastinal surgery |
| title | Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis |
| title_full | Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis |
| title_fullStr | Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis |
| title_full_unstemmed | Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis |
| title_short | Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis |
| title_sort | feasibility of video assisted thoracoscopic surgery via subxiphoid approach in anterior mediastinal surgery a meta analysis |
| topic | subxiphoid video-assisted thoracoscopic surgery subxiphoid approach thymoma meta-analysis anterior mediastinal surgery |
| url | https://www.frontiersin.org/articles/10.3389/fsurg.2022.900414/full |
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