ReviewEfficacy of the fissureless technique on decreasing the incidence of prolonged air leak after pulmonary lobectomy: A systematic review and meta-analysis

- This is the first meta-analysis to summary the efficacy of fissureless lobectomy.
- Fissureless lobectomy can significantly decrease the incidence of prolonged air leak.
- Fissureless lobectomy can significantly shorten the length of hospital stay.
- Fissureless technique is a superior and feasible alternative in pulmonary lobectomy.

ObjectiveThe objective of our study was to evaluate the efficacy and safety of fissureless technique in pulmonary lobectomy by applying a meta-analysis of the current evidence.MethodsWe searched the PubMed, EMBASE and the Web of Science databases to recognize the eligible articles. The relative risk (RR) and weighted mean difference (WMD) with the corresponding 95% confidence interval (CI) served as the summarized estimates for dichotomous variables and continuous variables, respectively. Sensitivity analysis and publication bias tests were also performed to perceive potential bias risks.ResultsThere were 6 studies with 843 surgical patients included into this meta-analysis. Finally, the meta-analysis demonstrated that fissureless technique could significantly reduce the incidence of prolonged air leak (PAL)[RR = 0.40; 95%CI=(0.24, 0.68); P = 0.001], the length of hospital stay [WMD = −0.52; 95%CI=(-0.87, −0.18); P = 0.003] and the duration of chest tube [WMD = −0.44; 95%CI=(-0.74, −0.14); P = 0.004]. Fissureless technique had also showed the benefit on decreasing the complication rate after lobectomy but without a statistical significance [RR = 0.77; 95%CI=(0.55, 1.07); P = 0.119]. In addition, no difference was observed in the operation time between the fissureless lobectomy and conventional lobectomy [WMD = 5.32; 95%CI=(-3.18, 13.83); P = 0.220].ConclusionsFissureless lobectomy is a superior alternative to conventional lobectomy in terms of preventing the PAL and shortening the length of hospital stay and chest tube duration. More multi-institution randomized controlled trials are required to confirm the validity of our findings in the future.