Impact of video-assisted thoracic surgery versus open thoracotomy on postoperative wound infections in lung cancer patients: A systematic review
DOI: https://doi.org/10.33024/minh.v8i5.930
Lung Cancer Open Thoracotomy Postoperative Wound Infections Video-Assisted Thoracic Surgery (VATS)
Abstract
Background: Lung cancer remains a leading cause of cancer-related mortality worldwide, with surgical resection being the primary curative approach for early-stage non-small cell lung cancer. Postoperative wound infections following thoracic surgery significantly impact patient outcomes, healthcare resources, and quality of life.
Purpose: To evaluate the incidence, risk factors, management, and outcomes of postoperative wound infections comparing Video-Assisted Thoracic Surgery (VATS) versus open thoracotomy in lung cancer patients.
Method: A systematic review with article selection guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The systematic review process begins with the formulation of clinical questions relevant to the topic. Before this, the authors establish PICOS criteria, which stand for: P (problem, patient, or population), I (intervention, prognostic factor, or exposure), C (comparison or control), O (outcome), and S (study design). For this article, P: Adult patients with diagnosed lung cancer who underwent surgical resection, I: Video-Assisted Thoracic Surgery (VATS), C: Open thoracotomy, O: Incidence of postoperative wound infections, infection severity, causative microorganisms, time to infection development, treatment approaches, and impact on hospital stay, S: Randomized controlled trials. The article search was conducted systematically using the keywords: "Video-Assisted Thoracic Surgery,” AND "VATS," AND "Open Thoracotomy," AND "Lung Cancer," AND "Pulmonary Carcinoma," AND "Surgical Site Infection," AND "Wound Infection," AND "Postoperative Complications," AND "Surgical Wound Dehiscence," AND "Surgical Outcomes," AND "Minimally Invasive Surgery".
Results: The analysis showed that VATS had lower overall complication rates, reduced mortality, and shorter hospital stays compared to open thoracotomy, especially in high-risk patients like those with obesity. VATS conversion to thoracotomy significantly increased complications and mortality. Robot-assisted thoracic surgery offered additional benefits, including less blood loss and lower conversion rates than conventional VATS.
Conclusion: VATS is preferred over open thoracotomy for lung cancer due to lower complications, mortality, and shorter hospital stays. Conversion to thoracotomy increases risks. Robotic surgery offers additional benefits but at higher costs. Overall, minimally invasive approaches reduce wound-related complications.
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References
Aeschbacher, P., Nguyen, T. L., Dorn, P., Kocher, G. J., & Lutz, J. A. (2021). Surgical Site Infections Are Associated With Higher Blood Loss And Open Access In General Thoracic Practice. Frontiers In Surgery, 8, 656249.
Al-Jabir, A., Kerwan, A., Nicola, M., Alsafi, Z., Khan, M., Sohrabi, C., & Agha, R. (2020). Impact Of The Coronavirus (COVID-19) Pandemic On Surgical Practice-Part 2 (Surgical Prioritisation). International Journal Of Surgery, 79, 233-248.
Allocca, V., Guidelli, L., Galgano, A., Benedetti, L., Fabbroni, R., Bianco, A., & Scala, R. (2024). Safety And Diagnostic Yield Of Medical Pleuroscopy (MP) Performed Under Balanced Analgosedation By A Pneumological Team Compared To Video-Assisted Thoracic Surgery (VATS): A Retrospective Controlled Real-Life Study (TORAPO). Diagnostics, 14(6), 569.
Ayad, Z. (2024). A Meta-Analysis Comparing Surgical Site Wound Infection Following Single-Incision Versus Multiple-Incision Video-Assisted Thoracoscopic Surgery Lobectomy For Patients With Lung Cancer. Al-Mustaqbal Journal Of Pharmaceutical And Medical Sciences, 2(2), 5.
Basu, S., Goswami, A. G., David, L. E., & Mudge, E. (2024). Psychological Stress On Wound Healing: A Silent Player In A Complex Background. The International Journal Of Lower Extremity Wounds, 23(3), 365-371.
Christensen, T. D., Bendixen, M., Skaarup, S. H., Jensen, J. U., Petersen, R. H., Christensen, M., & Laursen, C. B. (2022). Intrapleural Fibrinolysis And Dnase Versus Video-Assisted Thoracic Surgery (VATS) For The Treatment Of Pleural Empyema (FIVERVATS): Protocol For A Randomised, Controlled Trial–Surgery As First-Line Treatment. BMJ Open, 12(3), E054236.
Guerrera, F., Brunelli, A., Falcoz, P. E., Filosso, P. L., Szanto, Z., Lausi, P. O., & Ruffini, E. (2023). Video-Assisted Thoracic Surgery Or Thoracotomy For Lung Cancer Surgery In Obese Patients? An Analysis Of The European Society Of Thoracic Surgeons Database. European Journal Of Cardio-Thoracic Surgery, 64(5), Ezad368.
Jindal, R., Nar, A. S., Mishra, A., Singh, R. P., Aggarwal, A., & Bansal, N. (2021). Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy In The Management Of Empyema: A Comparative Study. Journal Of Minimal Access Surgery, 17(4), 470-478.
Khalaf, A. E. M., Ghoneim, A. E., Mahmoud, A. B., & Abdelwahab, A. A. (2023). Video Assisted Thoracoscopic Surgery Vs Thoracotomy In Management Of Post Traumatic Retained Hemothorax: A Randomized Study. The Cardiothoracic Surgeon, 31(1), 11.
Lampridis, S., Maraschi, A., Le Reun, C., Routledge, T., & Billè, A. (2023). Robotic Versus Video-Assisted Thoracic Surgery For Lung Cancer: Short-Term Outcomes Of A Propensity Matched Analysis. Cancers, 15(8), 2391.
Manolache, V., Motas, N., Davidescu, M., Bluoss, C., Rus, O., Tanase, B., & Gonzalez-Rivas, D. (2022). Minimally Invasive Thoracic Surgery-Video Assisted Thoracic Surgery: Technique And Indications. Chirurgia (Bucur), 117(1), 101-9.
Ma, J., Li, X., Zhao, S., Wang, J., Zhang, W., & Sun, G. (2021). Robot-Assisted Thoracic Surgery Versus Video-Assisted Thoracic Surgery For Lung Lobectomy Or Segmentectomy In Patients With Non-Small Cell Lung Cancer: A Meta-Analysis. BMC Cancer, 21, 1-16.
Miyajima, M., Maki, R., Arai, W., Tsuruta, K., Shindo, Y., Nakamura, Y., & Watanabe, A. (2022). Robot-Assisted Vs. Video-Assisted Thoracoscopic Surgery In Lung Cancer. Journal Of Thoracic Disease, 14(6), 1890.
Ochi, T., Suzuki, H., Hirai, Y., Yamanaka, T., Matsumoto, H., Kaiho, T., & Yoshino, I. (2023). Robot-Assisted Thoracic Surgery Versus Video-Assisted Thoracic Surgery For Mediastinal Lesions. Journal Of Thoracic Disease, 15(7), 3840.
Rokah, M., & Ferri, L. (2025). Implementation Of Enhanced Recovery After Surgery Program For Lung Resection. Current Challenges In Thoracic Surgery, 7.
Salvador, I. C. M. C., Da Nobrega Oliveira, R. E. N., De Almeida Silva, I., Torres, L. A. F., Camarotti, M. T., Passos, F. S., & Mariani, A. W. (2025). Comparative Outcomes Video-Assisted Thoracic Surgery Versus Open Thoracic Surgery In Pulmonary Echinococcosis: A Systematic Review And Meta-Analysis. General Thoracic And Cardiovascular Surgery, 1-8.
Seitlinger, J., Olland, A., Guinard, S., Massard, G., & Falcoz, P. E. (2021). Conversion From Video-Assisted Thoracic Surgery (VATS) To Thoracotomy During Major Lung Resection: How Does It Affect Perioperative Outcomes?. Interactive Cardiovascular And Thoracic Surgery, 32(1), 55-63.
Spiezia, L., Liew, A., Campello, E., Di Gregorio, G., Zuin, A., & Simioni, P. (2020). Thrombotic Risk Following Video-Assisted Thoracoscopic Surgery Versus Open Thoracotomy: A Systematic Review And Meta-Analysis. Interactive Cardiovascular And Thoracic Surgery, 30(4), 573-581.
Steen, K., Sørensen, J., Christensen, M., Petersen, R. H., Naidu, B., Bendixen, M., & Christensen, T. D. (2023). Comparison Of Video Assisted Thoracoscopic Surgery And Thoracotomy For Treatment Of Pleural Infection Stage II And III: A Literature Review. Journal Of Thoracic Disease, 15(11), 6323.
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global Cancer Statistics 2020: GLOBOCAN Estimates Of Incidence And Mortality Worldwide For 36 Cancers In 185 Countries. CA: A Cancer Journal For Clinicians, 71(3), 209-249.
Wang, J. Q., & Ma, Z. J. (2025). Impact Of Video-Assisted Thoracic Surgery Versus Open Thoracotomy On Postoperative Wound Infections In Lung Cancer Patients: A Systematic Review And Meta-Analysis. BMC Pulmonary Medicine, 25(1), 159.
Wu, W., Zhao, Y., Zhang, Z., Jiang, J., Feng, C., Qin, D., & Lin, F. (2023). RETRACTED: Effect Of Single‐Port Video‐Assisted Thoracoscopy On Surgical Site Wound Infection And Healing In Patients With Lung Cancer: A Meta‐Analysis. International Wound Journal, 20(9), 3483-3490.
Zhang, H., Yang, Q., Liu, T., & Liu, Y. (2021). [Retracted] Curative Effect Observation And Prognosis Analysis Of Video‐Assisted Thoracic Surgery And Thoracotomy In Patients With Hemopneumothorax. Evidence‐Based Complementary And Alternative Medicine, 2021(1), 3937420.
Zhang, O., Alzul, R., Carelli, M., Melfi, F., Tian, D., & Cao, C. (2022). Complications Of Robotic Video-Assisted Thoracoscopic Surgery Compared To Open Thoracotomy For Resectable Non-Small Cell Lung Cancer. Journal Of Personalized Medicine, 12(8), 1311.
Zhang, X. X., Song, C. T., Gao, Z., Zhou, B., Wang, H. B., Gong, Q., & Li, H. F. (2021). A Comparison Of Non-Intubated Video-Assisted Thoracic Surgery With Spontaneous Ventilation And Intubated Video-Assisted Thoracic Surgery: A Meta-Analysis Based On 14 Randomized Controlled Trials. Journal Of Thoracic Disease, 13(3), 1624.
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