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

Introduction: Empyema is a respiratory disease that has increased seriously in the past two decades. The usual treatments for the stage III patients includes thoracotomy and video assisted thoracoscopic surgery. Hence a systematic review was conducted to compare the effectiveness and safety of the two procedures. Materials and Methods: In this search systematic review the databases of PubMed, Cochrane Library, Scopus, NIHR HTA, Embace, Magiran and SID were searched from 1990 until the end of June 2018. We used CASP checklist to evaluate the quality. Data analysis was performed in STATA software. The pooled effectiveness results were demonstrated in Forest plat. Results: Among initially 2228 retrieved records, four studies entered in the final stage of review, among which three were included in the meta-analysis. The findings showed that there was 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 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. Conclusion: There is no statistically significant difference in the operation of video assisted thoracoscopic surgery with thoracotomy in terms of effectiveness and safety. Nevertheless, the results should be considered cautiously due to the little number of included studies.