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Purpose <p>This study aimed to compare clamshell incision versus median sternotomy (MS) and bilateral anterolateral thoracotomy (BAT) for double lung transplantation. The goal was to evaluate their impact on key postoperative outcomes such as sternal major complications (SMC), operative mortality, and long-term patient survival, given the ongoing debate in the surgical community regarding the optimal technique for reducing postoperative morbidity and improving recovery.</p> Methods <p>This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were assessed. A random-effects model was used to calculate the odds ratios (ORs) and mean differences (MDs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I<sup>2</sup> statistics. Statistical analysis was performed with R Software, version 4.4.0.</p> Results <p>A total of 10 studies involving 1,020 patients were included, of whom 429 underwent clamshell incision, 223 underwent MS, and 368 underwent BAT. Compared with clamshell, BAT showed a significant reduction in SMC rates (OR 0.08; 95% CI 0.02–0.31; <i>p</i> &lt; 0.01; I²=0%) and surgical time (MD -47.29&#xa0;min; 95% CI -69.45, -25.14; <i>p</i> &lt; 0.01; I²=62%;). There were no significant differences for pneumonia, in-hospital mortality, or severe graft rejection. In addition, comparing MS with clamshell incision, there were no significant differences in blood transfusion, airway dehiscence, length of hospitalization, pneumonia, SMC, survival, ischemic time, or tracheostomy rates.</p> Conclusions <p>This meta-analysis found that BAT showed a significant reduction in SMC and surgical time compared to clamshell approach. However, no significant differences in survival or major complications were found between the techniques. Further randomized controlled trials are needed to validate these findings and assess the long-term efficacy of these techniques.</p> <p><b>Trial Registry</b>: International Prospective Register of Systematic Reviews; Nº: CRD42024587396; URL: <a href="https://www.crd.york.ac.uk/prospero/">https://www.crd.york.ac.uk/prospero/</a>.</p>

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Comparative Outcomes of Clamshell, Median Sternotomy, and Bilateral Thoracotomy Incisions in Bilateral Lung Transplantation: A Meta-Analysis

  • 期刊论文

  • 发表日期：

    2026年1月6日

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  • Rachid Eduardo Noleto da Nobrega Oliveira,
  • Felipe S. Passos,
  • Isabella Cabianca Moriguchi Caetano Salvador,
  • Ingryd de Almeida Silva,
  • Aliny Silva de Lima,
  • Bernardo Mulinari Pessoa,
  • Irene Bello

摘要

Purpose

This study aimed to compare clamshell incision versus median sternotomy (MS) and bilateral anterolateral thoracotomy (BAT) for double lung transplantation. The goal was to evaluate their impact on key postoperative outcomes such as sternal major complications (SMC), operative mortality, and long-term patient survival, given the ongoing debate in the surgical community regarding the optimal technique for reducing postoperative morbidity and improving recovery.

Methods

This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were assessed. A random-effects model was used to calculate the odds ratios (ORs) and mean differences (MDs), with 95% confidence intervals (CIs). Heterogeneity was assessed with I2 statistics. Statistical analysis was performed with R Software, version 4.4.0.

Results

A total of 10 studies involving 1,020 patients were included, of whom 429 underwent clamshell incision, 223 underwent MS, and 368 underwent BAT. Compared with clamshell, BAT showed a significant reduction in SMC rates (OR 0.08; 95% CI 0.02–0.31; p < 0.01; I²=0%) and surgical time (MD -47.29 min; 95% CI -69.45, -25.14; p < 0.01; I²=62%;). There were no significant differences for pneumonia, in-hospital mortality, or severe graft rejection. In addition, comparing MS with clamshell incision, there were no significant differences in blood transfusion, airway dehiscence, length of hospitalization, pneumonia, SMC, survival, ischemic time, or tracheostomy rates.

Conclusions

This meta-analysis found that BAT showed a significant reduction in SMC and surgical time compared to clamshell approach. However, no significant differences in survival or major complications were found between the techniques. Further randomized controlled trials are needed to validate these findings and assess the long-term efficacy of these techniques.

Trial Registry: International Prospective Register of Systematic Reviews; Nº: CRD42024587396; URL: https://www.crd.york.ac.uk/prospero/.