ReviewThoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: A meta-analysis
Introduction
Thymoma is a relatively rare tumor, with the overall incidence of 0.15 cases per 100,000.1 It accounts for 20% of the overall mediastinal tumors and 50% of all the anterior mediastinal tumors, and is considered to be the most common tumor of the anterior mediastinum.2, 3 Thymoma is an indolent tumor, with a tendency toward local recurrence rather than metastasis.4 Surgery was still considered as the mainstay treatment of thymoma, especially for early stage disease. As reported that the 5-year overall survival rates for completely resected stage I and stage II thymoma are notable, ranging from 89% to 100% and 71% to 95%, respectively. For advanced thymoma, debulking surgery may perhaps improve overall survival.5, 6 Nowadays, the progress in technology and instruments has enabled thoracoscopic thymectomy (TT) for thymoma. However, the safety and long-term oncological outcomes of VATS are still under the concern of thoracic surgeons. Some studies compared the safety and efficacy of thoracoscopic thymectomy (OT) with open thymectomy (TT), but the results remains controversial. Due to the limited sample size and static power in individual study, a meta-analysis is necessary to evaluate safety and efficacy of TT procedure in comparison with OT for patients with thymoma.
Section snippets
Literature search
A comprehensive literature search was conducted in the databases of PubMed, EMBASE and Web of Science. The last search time was Oct 31, 2015. The following terms and combinations were used to identify studies: video-assisted thoracic surgery; VATS; thoracoscopy; thymectomy; minimal invasive surgery and thymoma. Furthermore, references of retrieved articles and reviews were manually screened for additional studies.
Inclusion and exclusion criteria
The inclusion criteria were applied to identify the eligible studies: (1)
Eligible studies
Fig. S1 (Supplementary files, Fig. S1) summarized our process of articles selection. The initial research yielded 224 potential articles, after reading the titles and abstracts, 192 studies were excluded because they were obviously irrelevant to our study design. The other 32 studies with full texts were carefully assessed for eligibility. As a results, 18 studies were excluded for following reasons: six studies were non-comparative studies that they only reported VATS groups, five studies did
Discussion
Advocates of VATS emphasize that this minimally invasive procedure is associated with less tissue trauma, lower complication rates, reduced postoperative pain and scarring, and shorter hospital stay. The overall advantage of thoracoscopy over thoracotomy in terms of patient recovery was fairly well established in VATS lobectomy, VATS assisted esophagectomy and other thoracic procedures.26, 27 Our analysis suggested that when compared with conventional OT approach, TT was associated with less
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