fsurg-09-900414_Table_5_v1_Feasibility of Video-Assisted Thoracoscopic Surgery via Subxiphoid Approach in Anterior Mediastinal Surgery: A Meta-Analysis.docx

BackgroundAccumulating researches show potential advantages of video-assisted thoracoscopic surgery (VATS) via the subxiphoid approach, and this meta-analysis aims to investigate the efficacy and safety of the subxiphoid approach for anterior mediastinal surgery.
MethodsRelevant studies were retrieved by searching Embase and PubMed databases (from the inception to October 1, 2021). Primary outcomes included postoperative pain, intraoperative blood loss, operation time, chest tube duration, and hospital length of stay. All meta-analyses were performed by using random-effects models.
ResultsOverall, 14 studies with 1,279 patients were included, with 504 patients undergoing anterior mediastinal surgery via subxiphoid approach and 775 via other approaches. The pooled results indicated that the subxiphoid approach was associated with reduced postoperative pain indicated by visual analog scale [weight mean difference (WMD): 24 h: −2.27, 95% CI, −2.88 to −1.65, p < 0.001; 48–72 h: −1.87, 95% CI, −2.53 to −1.20, p < 0.001; 7 days: −0.98, 95% CI, −1.35 to −0.61, p < 0.001], shortened duration of chest tube drainage (WMD: −0.56 days, 95% CI, −0.82 to −0.29, p < 0.001), shortened hospital length of stay (WMD: −1.46 days, 95% CI, −2.28 to −0.64, p < 0.001), and reduced intraoperative blood loss (WMD: −26.44 mL, 95% CI, −40.21 to −12.66, p < 0.001) by comparison with other approaches in anterior mediastinal surgery. Besides, it has no impact on operation time and the incidence of complications of transition to thoracotomy, postoperative pleural effusion, phrenic nerve palsy, and lung infection.
ConclusionsOur study suggests that the subxiphoid approach is a feasible alternative approach and even can be a better option for anterior mediastinal surgery. Further, large-scale multicenter randomized controlled trials are needed to validate this finding.

背景 越来越多的研究显示剑突下入路电视辅助胸腔镜手术（video-assisted thoracoscopic surgery, VATS）具有潜在优势，本荟萃分析（meta-analysis）旨在探讨剑突下入路应用于前纵隔手术的有效性与安全性。
方法 通过检索Embase与PubMed数据库（建库至2021年10月1日）获取相关研究。主要结局指标包括术后疼痛、术中失血量、手术时长、胸腔引流管留置时间及住院时长。所有荟萃分析均采用随机效应模型（random-effects models）进行。
结果 最终纳入14项研究，共计1279例患者，其中504例接受剑突下入路前纵隔手术，775例接受其他入路手术。合并分析结果显示，与其他入路相比，剑突下入路可显著降低术后疼痛（以视觉模拟评分法（visual analog scale）评估：术后24小时：加权均数差（weight mean difference, WMD）=-2.27，95%置信区间（95% confidence interval, 95%CI）：-2.88~-1.65，p<0.001；术后48~72小时：WMD=-1.87，95%CI：-2.53~-1.20，p<0.001；术后7天：WMD=-0.98，95%CI：-1.35~-0.61，p<0.001），缩短胸腔引流管留置时间（WMD=-0.56天，95%CI：-0.82~-0.29，p<0.001），缩短住院时长（WMD=-1.46天，95%CI：-2.28~-0.64，p<0.001），并减少术中失血量（WMD=-26.44mL，95%CI：-40.21~-12.66，p<0.001）。此外，该入路对手术时长、中转开胸并发症发生率、术后胸腔积液、膈神经麻痹及肺部感染发生率无显著影响。
结论 本研究表明，剑突下入路是前纵隔手术的一种可行替代方案，甚至可作为更优选择。未来仍需开展大规模多中心随机对照试验以验证本研究结论。