Impact of video-assisted thoracic surgery versus open thoracotomy on postoperative wound infections in lung cancer patients: a systematic review and meta-analysis

Background: Lung cancer surgery has evolved significantly, with minimally invasive video-assisted thoracic surgery (VATS) procedures being compared with traditional open thoracotomies. The incidence of postoperative wound infections is a significant factor influencing the choice of surgical technique. This systematic review and meta-analysis aim to evaluate the impact of thoracoscopic versus open thoracotomy procedures on postoperative wound infections in lung cancer patients. Methods: Following PRISMA guidelines, a comprehensive search across PubMed, Embase, Web of Science, and the Cochrane Library was conducted on September 19, 2023, without time or language restrictions. Peer-reviewed randomized controlled trials, cohort studies, and case-control studies reporting on postoperative wound infections were included. Studies not differentiating between surgical techniques or focusing on irrelevant populations were excluded. Data extraction and quality assessment were independently carried out by two reviewers, using a fixed-effect model for meta-analysis due to the absence of significant heterogeneity (I2 = 0.0%, P = 0.766). Results: A total of six articles were included. The quality assessment indicated a low risk of bias in most domains. The pooled results showed that open thoracotomy procedures had a twofold increased risk of postoperative wound infections (OR = 2.00, 95% CI: 1.04–3.85) compared to VATS procedures. Publication bias assessment using funnel plots and Egger’s test revealed no significant biases (P > 0.05). Conclusions: The findings suggest that VATS is associated with a lower risk of postoperative wound infections compared to open thoracotomy, which has implications for surgical decision-making in lung cancer treatment. Clinical trial number: Not applicable. © The Author(s) 2025.