Comparison of video-assisted thoracoscopic surgery with thoracotomy for treatment of chronic empyema: A systematic review study

Context:Empyema is a respiratory disease that has increased seriously in the past two decades. The usual treatments for stage III patients include thoracotomy and video-assisted thoracoscopic surgery. Hence, a systematic review of the literature was conducted to investigate the effectiveness and safety of the two procedures. Methods:Electronic databases of PubMed, Cochrane Library, Scopus, NIHR HTA, Embase, Magiran, and SID were searched from 1990 until the end of June 2018. We used the Critical Appraisal Skills Programme (CASP) checklist for quality assessment. Data analysis was performed in Stata software. The pooled effectiveness results were demonstrated in Forest plats. Results:Among 2,228 records initially retrieved, four studies entered the final stage of review, among which three were included in the meta-analysis. The findings showed no significant difference between the two methods of thoracoscopic surgery and thoracotomy in the treatment of organizational empyema in terms of duration of surgical operation (MD = 1.33, %95 CI:-0.66-3.31, P = 0.18). Postoperative hospital stay was not statistically different between the two surgical methods (MD = 1.68, %95 CI:-0.20-3.56, P = 0.08). In terms of safety, there was no particular risk for patients across the surgeries. Conclusions:There is no statistically significant difference between video-assisted thoracoscopic surgery and thoracotomy in terms of effectiveness and safety. Nevertheless, the results should be considered cautiously due to the little number of included studies.