Objective To systematically evaluate the profitability and efficacy of neoadjuvant chemotherapy in patients with stage Ⅲa non-small cell lung cancer. Methods Randomized controlled trials (RCT) on neoadjuvant chemotherapy for stage Ⅲa non-small cell lung cancer were collected from WangFang Data database, Web of Science, PubMed, EMbase, CNKI, The Cochrane Library, VIP and CBM databases. From building to October 2017. After two independent reviewers screened the literature, extracted data and assessed the risk of being included in the study, Meta-analysis was performed using RevMan 5.3 software. Results A total of 15 RCT were included, including 1899 non-small cell lung cancer patients. The results of Meta analysis showed that the resection rate of R0 in neoadjuvant chemotherapy group was significantly higher than that in control group (OR=2.04, 95%CI 1.52 to 2.74, P<0.05), and there was no significant difference in postoperative complications between two groups (OR=1.23, 95%CI 0.89 to 1.69, P=0.22). In terms of survival rate, the neoadjuvant chemotherapy group could improve patients for one year (OR=1.38, 95%CI 1.01 to 1.88, P=0.04), three years (OR=1.57, 95%CI 1.16 to 2.12, P=0.004) and 5 years survival rate (OR=2.09, 95%CI 1.24 to 3.53, P=0.005) significance of learning. Conclusion Compared with the control group, neoadjuvant chemotherapy can improve the surgical R0 resection rate and the one, three and five year survival rate of patients with stage Ⅲa non-small cell lung cancer without increasing the postoperative complications. Due to the quantity and quality limitations of the included studies, the above conclusion still needs to be verified by more high-quality research.
ObjectiveTo compare postoperative efficacy of thoracoscopic partial pneumonectomy with or without thoracic drainage tube postoperatively.MethodsThe PubMed, Wanfang database, CNKI and Web of Science from January 2000 to August 2020 were searched by computer to collect randomized controlled studies (RCT), cohort studies and case-control studies on the efficacy of chest drainage tube placement versus no placement after thoracoscopic partial pneumonectomy. Two reviewers independently screened articles and extracted data to evaluate the risk of literature bias. Meta-analysis was performed with RevMan software.ResultsA total of 15 articles were included, including 1 RCT and 14 cohort studies. A total of 1 524 patients were enrolled, including 819 patients in the test group (no postoperative chest drainage tube group) and 705 patients in the control group (postoperative chest drainage tube group). Compared with the control group, the length of hospital stay in the test group was shorter (MD=–1.3, 95%CI –1.23 to –0.17, P<0.000 01) and the incidence of postoperative pneumothorax was higher (RD=0.06, 95%CI 0.01 to 0.10, P=0.01). There was no significant difference between the two groups in operation time (MD=–2.37, 95%CI –7.04 to 2.30, P=0.32), the incidence of postoperative complications (RR=2.43, 95%CI 0.79 to 1.80, P=0.39), the reintervention rate of postoperative complications (RD=0.02, 95%CI=–0.00 to 0.04, P=0.05), postoperative subcutaneous emphysema (RD=0.02, 95%CI –0.01 to 0.06, P=0.20) and the incidence of postoperative pleural effusion (RD=0.04, 95%CI –0.00 to 0.09, P=0.10) .ConclusionCompared with the patients with chest drainage tube placement after thoracoscopic partial pneumonectomy (the control group), the test group can shorten the hospital stay. Although the incidence of postoperative pneumothorax is higher than that of the control group, the operation time, incidence of postoperative subcutaneous emphysema and in-hospital complications, and reintervention rate of in-hospital complications are not statistically significant between the two groups. Therefore no chest drainage tube may be placed after partial pneumonectomy.