title: Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer.
abstract: OBJECTIVE
  The current randomized trials comparing video-assisted thoracic surgery (VATS) lobectomy with open lobectomy for patients with early-stage non-small-cell lung cancer (NSCLC) have been of small size. We performed the present meta-analysis of the randomized and nonrandomized comparative studies in an attempt to assess the safety and efficacy of VATS lobectomy.
  
  
  METHODS
  Electronic searches identified 21 eligible comparative studies (two randomized and 19 nonrandomized) for inclusion. Two reviewers independently appraised each study. Meta-analysis was performed by combining the results of reported incidence of morbidity and mortality, recurrence, and 5-year mortality rates. The relative risk (RR) was used as a summary statistic.
  
  
  RESULTS
  There were no significant statistical differences between VATS and open lobectomy in terms of postoperative prolonged air leak (P = .71), arrhythmia (P = .86), pneumonia (P = .09), and mortality (P = .49). VATS did not demonstrate any significant difference in locoregional recurrence (P = .24), as compared with the open lobectomy arm, but the data suggested a reduced systemic recurrence rate (P = .03) and an improved 5-year mortality rate of VATS (P = .04). There was no evidence to suggest heterogeneity of trial results. Fourteen studies reported VATS to open lobectomy conversion rate ranging from 0% to 15.7% (median = 8.1%).
  
  
  CONCLUSIONS
  Both randomized and nonrandomized trials suggest that VATS lobectomy is an appropriate procedure for selected patients with early-stage NSCLC when compared with open surgery.
authors.affiliation: University of Sydney, Department of Cardiothoracic Surgery, The Royal Prince Alfred Hospital, Sydney, NSW, Australia. Tristan.Yan@unsw.edu.au
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
authors.forename: Deborah
authors.initials: D
authors.lastname: Black
authors.forename: Paul G
authors.initials: PG
authors.lastname: Bannon
authors.forename: Brian C
authors.initials: BC
authors.lastname: McCaughan
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000401:mortality / Q000601:surgery*; D002986:Clinical Trials as Topic; D006801:Humans; D008175:Lung Neoplasms / Q000401:mortality / Q000601:surgery*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D011013:Pneumonectomy / Q000379:methods*; D020535:Video-Assisted Surgery