title: Video-Assisted versus Open Lobectomy in Patients with Compromised Lung Function: A Literature Review and Meta-Analysis.
abstract: BACKGROUND
  It has been suggested that video-assisted (VATS) lobectomy is safer than open lobectomy in patients with compromised lung function, but data regarding this are limited. We assessed acute outcomes of VATS compared to open lobectomy in these high-risk patients using a systematic literature review and meta-analysis of data.
  
  
  METHODS
  The databases PubMed and Scopus were searched for studies published between 2000 and 2013 that reported mortality and morbidity of VATS in high-risk lung cancer patients defined as having compromised pulmonary or cardiopulmonary function. Study selection, data collection and critical assessment of the included studies were performed according to the recommendations of the Cochrane Collaboration.
  
  
  RESULTS
  Three case-control studies and three case series that included 330 VATS and 257 open patients were identified for inclusion. Operative mortality, overall morbidity and pulmonary morbidity were 2.5%, 39.3%, 26.2% in VATS patients and 7.8%, 57.5%, 45.5% in open lobectomy group, respectively. VATS lobectomy patients experienced significantly lower pulmonary morbidity (RR = 0.45; 95% CI, 0.30 to 0.67; p = 0.0001), somewhat reduced operative mortality (RR = 0.51; 95% CI, 0.24 to 1.06; p = 0.07), but no significant difference in overall morbidity (RR = 0.68; 95% CI, 0.41 to 1.14; p = 0.14).
  
  
  CONCLUSIONS
  The existing data suggest that VATS lobectomy is associated with lower risk for pulmonary morbidity compared with open lobectomy in lung cancer patients with compromised lung function.
authors.affiliation: Division of Thoracic Surgery, Klinik Schillerhoehe, Center for Pneumology and Thoracic Surgery, Teaching Hospital of the University of Tuebingen, Gerlingen, Germany.
authors.forename: Ruoyu
authors.initials: R
authors.lastname: Zhang
authors.affiliation: Department of Surgery and The Cancer Research Center, The University of Chicago, Chicago, Illinois, United States of America.
authors.forename: Mark K
authors.initials: MK
authors.lastname: Ferguson
mesh_terms: D006334:Heart Function Tests; D017052:Hospital Mortality; D006801:Humans; D008175:Lung Neoplasms / Q000503:physiopathology / Q000601:surgery*; D012129:Respiratory Function Tests; D020535:Video-Assisted Surgery