The therapeutic effectiveness of three-dimensional video-assisted thoracic surgery in the management of esophageal cancer

OBJECTIVES The comparative benefits of three-dimensional (3 D) versus two-dimensional (2 D) video-assisted thoracic surgery (VATS) for oesophageal cancer remain uncertain. This meta-analysis aims to assess the efficacy and safety profiles of 3 D and 2 D VATS procedures in the management of oesophageal cancer. METHODS A comprehensive literature search was conducted utilizing the PubMed, Cochrane Library, and China National Knowledge Infrastructure (CNKI) databases for studies published up to August 2025. Eligible studies were those comparing the efficacy and safety profiles of 3 D versus 2 D VATS. For data synthesis, continuous variables were evaluated using standardized mean differences (SMD), while dichotomous outcomes were assessed with odds ratios (OR); all effect measures are reported with 95% confidence intervals (CI) and corresponding P-values. RESULTS Eight studies involving 1273 patients (608 undergoing 3 D VATS and 665 undergoing 2 D VATS) demonstrated that the 3 D VATS approach was associated with significantly decreased intraoperative blood loss (-2.27; 95% CI: -3.45 to -1.09; p < 0.05) and reduced operative duration (-0.65; 95% CI: -1.15 to -0.16; p < 0.05) compared to the 2 D technique. However, no statistically significant differences were observed between the two groups in terms of postoperative drainage time, postoperative hospitalization duration, total postoperative drainage volume, incidence of postoperative complications and number of lymph node dissection. CONCLUSIONS This meta-analytic study demonstrates that potential clinical benefits of 3 D VATS over the 2 D approach for oesophageal cancer resection, such as decreased intraoperative blood loss and reduced operative duration.