Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis

Lu Lv, Weidong Hu, Yanchen Ren, Xiaoxuan Wei, Lu Lv, Weidong Hu, Yanchen Ren, Xiaoxuan Wei

Abstract

Background and objectives: The safety and effectiveness of minimally invasive esophagectomy (MIE) in comparison with the open esophagectomy (OE) remain uncertain in esophageal cancer treatment. The purpose of this meta-analysis is to compare the outcomes of the two surgical modalities.

Methods: Searches were conducted in MEDLINE, EMBASE, and ClinicalTrials.gov with the following index words: "esophageal cancer", "VATS", "MIE", "thoracoscopic esophagectomy", and "open esophagectomy" for relative studies that compared the effects between MIE and OE. Random-effect models were used, and heterogeneity was assessed.

Results: A total of 20 studies were included in the analysis, consisting of four randomized controlled trials and 16 prospective studies. MIE has reduced operative blood loss (P=0.0009) but increased operation time (P=0.009) in comparison with OE. Patients get less respiratory complications (risk ratio =0.74, 95% CI =0.58-0.94, P=0.01) and better overall survival (hazard ratio =0.54, 95% CI =0.42-0.70, P<0.00001) in the MIE group than the OE group. No statistical difference was observed between the two groups in terms of lymph node harvest, R0 resection, and other major complications.

Conclusion: MIE is a better choice for esophageal cancer because patients undergoing MIE may benefit from reduced blood loss, less respiratory complications, and also improved overall survival condition compared with OE. However, more randomized controlled trials are still needed to verify these differences.

Keywords: laparoscopic esophagectomy; postoperative prognosis; thoracoscopic esophagectomy.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Stages of the systematic review of the trials. Abbreviations: MIE, minimally invasive esophagectomy; RCT, randomized controlled trial.
Figure 2
Figure 2
Forest plots of surgical outcomes. Notes: (A) Forest plots of blood loss. (B) Forest plots of operation time. (C) Forest plots of number of lymph nodes harvest. (D) Forest plots of R0 resection. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; MIE, minimally invasive esophagectomy; OE, open esophagectomy.
Figure 3
Figure 3
Forest plot of respiratory complications. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; MIE, minimally invasive esophagectomy; OE, open esophagectomy; RCT, randomized controlled trial.
Figure 4
Figure 4
Forest plot of anastomotic leakage. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; MIE, minimally invasive esophagectomy; OE, open esophagectomy; RCT, randomized controlled trial.
Figure 5
Figure 5
Forest plots of anastomotic stricture, in-hospital mortality, and reoperation. Notes: (A) Forest plots of anastomotic stricture. (B) Forest plots of in-hospital mortality. (C) Forest plots of reoperation. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; MIE, minimally invasive esophagectomy; OE, open esophagectomy.
Figure 6
Figure 6
Forest plots of cardiovascular complications, chylothorax, and recurrent laryngeal paralysis. Notes: (A) Forest plots of cardiovascular complications. (B) Forest plots of chylothorax. (C) Forest plots of recurrent laryngeal paralysis. Abbreviations: CI, confidence interval; M–H, Mantel–Haenszel; MIE, minimally invasive esophagectomy; OE, open esophagectomy.
Figure 7
Figure 7
Forest plot of overall survival. Abbreviations: CI, confidence interval; MIE, minimally invasive esophagectomy; OE, open esophagectomy.
Figure 8
Figure 8
Funnel plots of postoperative complications. Notes: (A) Funnel plots of respiratory complications. (B) Funnel plots of cardiovascular complications. (C) Funnel plots of in-hospital mortality. (D) Funnel plots of anastomotic leakage. Abbreviations: OR, odds ratio; RR, relative ratio; RCT, randomized controlled trial; SE, standard error.

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Source: PubMed

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