Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis

Can Zhou, Li Zhang, Hua Wang, Xiaoxia Ma, Bohui Shi, Wuke Chen, Jianjun He, Ke Wang, Peijun Liu, Yu Ren, Can Zhou, Li Zhang, Hua Wang, Xiaoxia Ma, Bohui Shi, Wuke Chen, Jianjun He, Ke Wang, Peijun Liu, Yu Ren

Abstract

Background: Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM).

Objective: The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM).

Data sources: Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched.

Study selection: Data of randomized and non-randomized clinical trials related to MIO versus OE were included.

Interventions: Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.

Study appraisal and synthesis methods: Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran's Q and I2 statistics.

Results: A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49).

Limitation: Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.

Conclusions: Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Flow Diagram of the search…
Fig 1. Flow Diagram of the search and selection method.
Fig 2. MIO and Risk of In-Hospital…
Fig 2. MIO and Risk of In-Hospital Mortality (IHM).
Fig 3. MIO and Risk of Pulmonary…
Fig 3. MIO and Risk of Pulmonary Complications (PCs).
Fig 4. MIO and Risk of Pulmonary…
Fig 4. MIO and Risk of Pulmonary Embolism (PE).
Fig 5. MIO and Risk of Arrhythmia.
Fig 5. MIO and Risk of Arrhythmia.
Fig 6. MIO and Risk of Anastomotic…
Fig 6. MIO and Risk of Anastomotic Leak (AL).
Fig 7. MIO and Risk of Gastric…
Fig 7. MIO and Risk of Gastric Tip Necrosis (GTN).

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Source: PubMed

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