title: Video-assisted thoracoscopic surgery versus open thoracotomy in pulmonary metastasectomy: a meta-analysis of observational studies.
abstract: BACKGROUND
  Pulmonary metastasectomy via a traditional open thoracotomy is effective for the treatment of patients with pulmonary metastases. However, whether video-assisted thoracoscopic surgery (VATS) achieves similar clinical effects in terms of survival rates remains unclear. We conducted this meta-analytic study to compare VATS with open thoracotomy for pulmonary metastasectomy.
  
  
  METHODS
  Relevant studies were identified by searching PubMed from inception to December 2014. The overall and recurrence-free survival rates were measured in terms of hazard ratios (HRs) with VATS and open thoracotomy as the main outcomes.
  
  
  RESULTS
  Eight studies were included in our meta-analysis, which included 337 patients in the VATS group and 485 patients in the open thoracotomy group. The overall survival rate in the VATS group was statistically significantly higher than that in the open thoracotomy group [HR, 0.69; 95% confidence interval (CI), 0.55-0.87; P = 0.002]. The VATS group still had a higher overall survival rate after exclusion of the one low-quality study (HR, 0.78; 95% CI, 0.59-1.03), but the result was not statistically significant (P = 0.075). No difference in the recurrence-free survival rate was found between the two groups (HR, 0.86; 95% CI, 0.69-1.08). The subgroup analysis showed no difference between the two groups in either the overall survival rate (HR, 0.72; 95% CI, 0.50-1.04) or the recurrence-free survival rate (HR, 0.79; 95% CI, 0.59-1.08) in patients with metastases from colorectal cancer.
  
  
  CONCLUSIONS
  VATS is an alternative surgical approach for pulmonary metastasectomy in patients with resectable pulmonary metastases. Further large prospective studies are needed to identify the indications for VATS in patients with pulmonary metastases.
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Di
authors.initials: D
authors.lastname: Meng
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Linhai
authors.initials: L
authors.lastname: Fu
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Luming
authors.initials: L
authors.lastname: Wang
authors.affiliation: Department of Gastroenterology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Yining
authors.initials: Y
authors.lastname: Dai
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Lv
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
authors.forename: Jieping
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Thoracic Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China hujian_med@163.com.
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000556:secondary*; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000556:secondary / Q000601:surgery; D059146:Metastasectomy / Q000379:methods*; D064887:Observational Studies as Topic; D011013:Pneumonectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013908:Thoracotomy / Q000379:methods*
keywords: Pulmonary metastasis; Survival; Thoracotomy; Video-assisted thoracoscopic surgery