Survival outcome of VATS compared with open lobectomy for lung cancer: an individual patient data meta-analysis of randomised trials.

Reported advantages include less pain, fewer complications, faster recovery, and improved postoperative quality of life.

报道的优势包括疼痛减少、并发症减少、恢复更快以及术后生活质量提高。

The widespread adoption of VATS lobectomy is principally based on non-oncological benefits.

VATS肺叶切除术的广泛采用主要是基于非肿瘤学上的益处。

Its oncological equivalence to open surgery remains assumed as no single trial has been powered for survival. To address this important question, we sought to conduct an individual patient data meta-analysisof eligible randomised trials.

其与开放手术在肿瘤学上的等效性仍然被假定，因为没有一项试验具有足够的统计功效来评估生存。为了解决这个重要的问题，我们寻求对符合条件的随机试验进行个体患者数据的荟萃分析。

Methods

We systematically reviewed PubMed, MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials, limiting the searches to papers published between Jan 1, 2000, and June 13, 2025.

我们系统地回顾了PubMed、MEDLINE、Embase和Cochrane中央控制试验登记处的文献，将搜索范围限定在2000年1月1日至2025年6月13日之间发表的论文。

We included completed randomised controlled trials comparing VATS versus open lobectomy performed after the year 2000 conducted for clinical early-stage non-small-cell lung cancer in adults aged 18 years or older that collected information on mortality and disease recurrence.

我们纳入了已完成的随机对照试验，这些试验比较了2000年后进行的胸腔镜手术（VATS）与开胸肺叶切除术，针对的是18岁或以上成人早期非小细胞肺癌患者，且收集了有关死亡率和疾病复发的信息。

Individual patient data were extracted from the included studies, and authors were contacted where data were unavailable.

从所包含的研究中提取了个别患者数据，当数据不可用时，联系了作者。

The primary outcome was overall survival, and the secondary outcome was disease-free survival. Risk of bias was assessed using the Cochrane risk of bias tool for randomised trials.

主要结果是总生存期，次要结果是无病生存期。使用Cochrane随机试验风险偏倚工具评估了偏倚风险。

The primary analytical strategy was a one-stage random effects Cox proportional hazards model.

主要的分析策略是一种单阶段随机效应的Cox比例风险模型。

A two-stage approach was performed to assess consistency.

为了评估一致性，执行了两阶段方法。

Results

We screened 554 articles and three studies were eligible for inclusion.

我们筛选了554篇文章，其中三项研究符合纳入标准。

Data were provided for 1185 patients (586 randomised to VATS and 599 randomised to open lobectomy).

共有1185名患者的数据被提供（586名被随机分配到VATS组，599名被随机分配到开放性肺叶切除术组）。

Overall survivalfavoured VATS lobectomy, reflecting a 21% mortality risk reduction (pooled hazard ratio[HR] 0·79 [95% CI 0·65-0·96]).

总生存率倾向于支持VATS肺叶切除术，反映了21%的死亡风险降低（汇总风险比[HR] 0.79 [95% 置信区间 0.65-0.96]）。

Disease-free survival was similar in both groups (pooled HR 0·91 [0·75-1·12]).

两组的无病生存率相似（汇总HR 0.91 [0.75-1.12]）。

There was no evidence of statistical heterogeneity across trials for either outcome.

在任何结果中，试验间均未发现统计学异质性的证据。

interpretation

This meta-analysisprovides evidence that surgical access by VATS lobectomy improved overall survivalcompared with open surgery without any compromise to disease-free survival. These results underscore the importance of prioritising VATS when technically feasible as the access of choice for surgical resection of early-stage non-small-cell lung cancer.

这项荟萃分析提供了证据，表明与开放手术相比，通过VATS肺叶切除术的手术途径改善了总生存率，且没有损害无病生存率。

funding

National Institute for Health and Care Research.

国家健康与护理研究所。