Thoracoscopic Segmentectomy Versus Lobectomy For Stage Ⅰ Non-small Cell Lung Cancer:a Systematic Review And Meta-analysis

Background& Object:The extensive development of thoracoscopic segmental resection has increasingly shown its broad prospects for the treatment of stage I non-small cell lung cancer.This article explores the treatment of stage I thoracoscopic segmentectomy and lobectomy.The clinical efficacy of non-small cell lung cancer is to provide relevant evidence for clinical decision-making.Method:Computer searches were conducted on PubMed,the Cochrane Library,Embase,Web of Science,Science Direct,Ovid Medline,Scopus database,and Google Scholar.The search time was from the establishment of the library to March 2019.A comparative study of thoracic segmental resection and lobectomy for clinical stage I NSCLC was performed and meta-analysis was performed using Revman 5.3software.Restlus:A total of 13 retrospective clinical controlled studies were included in the study,with a total of 1800 patients,including 566 in the thoracoscopic segmental resection group and 1234 in the thoracoscopic lobectomy group.Meta-analysis showed that for clinical stage I NSCLC,the incidence of complications after laparoscopic resection and lobectomy(RR=0.78,95% CI: 0.59~1.02,P=0.07),postoperative recurrence rate(RR=0.78,95%CI:0.52~1.17,P=0.23),postoperative hospital stay(MD=-0.27,95%CI:-0.58 to-0.05,P=0.10)and 5-year survival rate(RR=0.94,95%CI:0.87~1.03,P=0.17),tumor-free survival time(RR=0.95,95%CI:0.92~1.09,P=0.34),operation time(MD=-0.43,95% CI:-10.10)~9.25,P=0.93)The difference was not statistically significant,but laparoscopic lung segmentectomy can reduce intraoperative blood loss(MD=-23.81,95% CI:-42.00~-5.63,P=0.01),shortening Posterior chest tube drainage time(MD=-0.31,95% CI:-0.51~-0.12,P=0.002),but in the lymph node dissection,the segmentectomy was less than the lobectomy,the number of lymph node dissection(MD=-4.89,95% CI:-7.57~-2.20,P=0.0004).Percentage ofpostoperative/preoperative FVC℅(MD=7.50,95%CI:5.81~9.18,P<0.00001)and1-year postoperative/preoperative FEV1℅(MD=8.26,95%CI:6.43~10.09,P<0.00001)The difference was statistically significant.Conclusion:In the course of clinical stage I NSCLC treatment,the two procedures were similar in terms of postoperative complications,operation time,recurrence rate,5-year survival rate,tumor-free survival time and hospital stay,and fewer lung segments in lymph node dissection.In lobectomy,thoracoscopic segmental resection is better in terms of intraoperative blood loss and postoperative chest drainage time.Thoracoscopic segmentectomy may be more suitable for early stage non-small cell lung cancer.treatment method.