Minimally invasive vs. open chest wall resection in non-small cell lung cancer: a systematic review and meta-analysis

Minimally invasive chest wall resection (MICWR) has emerged as an alternative to open chest wall resection (OCWR) for lung cancer. This meta-analysis aims to compare perioperative outcomes between MICWR and OCWR in order to evaluate the safety and feasibility of the minimally invasive approach. A systematic search of PubMed, Embase, and Cochrane Library was conducted until January 20, 2025, for studies comparing MICWR and OCWR in adult patients with non-small cell lung cancer (NSCLC). The effect measures included odds ratios (ORs) for binary outcomes and mean differences (MDs) for continuous outcomes. Statistical analysis was performed using random-effects models. Heterogeneity was assessed with I2 statistics. Three retrospective studies comprising 2,973 patients were included, with 26.3% undergoing MICWR and 73.7% undergoing OCWR. No significant differences were found in overall mortality [OR 1.12; 95% confidence interval (CI): 0.95 to 1.32; P=0.17; I2=0%] or 90-day mortality (OR 1.00; 95% CI: 0.74 to 1.34; P=0.98; I2=0%). MICWR significantly reduced overall complications (OR 0.36; 95% CI: 0.14 to 0.93; P=0.04; I2=0%). While primary analysis showed no significant difference in length of stay (LOS) (MD -4.92 days; 95% CI: -10.36 to 0.52; P=0.08; I2=84%), sensitivity analysis (leave-one-out) eliminated heterogeneity (I2=0%) and showed a significant LOS reduction favoring MICWR (MD -7.62 days; 95% CI: -11.34 to -3.90). MICWR offers comparable oncologic outcomes to OCWR while reducing postoperative complications. It may also shorten LOS in selected patients. However, evidence is limited to retrospective studies, warranting prospective trials to confirm these findings and define optimal criteria.