A systematic literature search identified 849 articles. After exclusion of articles that did not fulfill the eligibility criteria the project group assessed the twenty remaining publications including meta analyses. Eight full text articles and one meta analysis were included.
Regarding five years survival the latest published metaanalysis from 2013 was assessed and in addition the level of evidence was graded of two articles of medium quality published after the metaanalysis. Two other medium quality articles were graded for evidence regarding pain and shoulder function.
Evidence for better five years survival after VATS compared with OT was very low. No article was identified where quality of life was adequately assessed.
Patients operated using VATS technique had in two studies less pain day seven and day 90 postopertively. In addition the patients had a significantly lower demand for analgesic drugs. In a clinical perspective the reported level of pain was low, with wide variations and the differences were small comparing the two techniques. Assessment of shoulder function was reported in one article only. Shoulder function was however not reported discrete from other activities of daily living.
There is a low level of evidence according to GRADE (⊕⊕) that the level of pain within three months after VATS is lower as compared to OT.
The questions regarding better five years survival, quality of life, pain up to three years postoperatively and shoulder function after VATS as compared to OT cannot be answered. The level of evidence according to GRADE is very low (⊕).
Included and excluded articles