Comparison of postoperative immune function in patients with thoracic esophageal cancer after video-assisted thoracoscopic surgery or conventional open esophagectomy

Background: Oesophagectomy is a demanding operation that can be performed by different approaches including open surgery or a combination of minimal access techniques. This systematic review and network meta-analysis aimed to evaluate the clinical outcomes of open, minimally invasive and robotic oesophagectomy techniques for oesophageal cancer. Methods: A systematic literature search was conducted for studies reporting open oesophagectomy, laparoscopically assisted oesophagectomy (LAO), thoracoscopically assisted oesophagectomy (TAO), totally minimally invasive oesophagectomy (MIO) or robotic MIO (RAMIO) for oesophagectomy. A network meta-analysis of intraoperative (operating time, blood loss), postoperative (overall complications, anastomotic leaks, chyle leak, duration of hospital stay) and oncological (R0 resection, lymphadenectomy) outcomes, and survival was performed. Results: Ninety-eight studies involving 32 315 patients were included in the network meta-analysis (open 17 824, 55⋅2 per cent; LAO 1576, 4⋅9 per cent; TAO 2421 7⋅5 per cent; MIO 9558, 29⋅6 per cent; RAMIO 917, 2⋅8 per cent). Compared with open oesophagectomy, both MIO and RAMIO were associated with less blood loss, significantly lower rates of pulmonary complications, shorter duration of stay and higher lymph node yield. There were no significant differences between surgical techniques in surgical-site infections, chyle leak, and 30-and 90-day mortality. MIO and RAMIO had better 1-and 5-year survival rates respectively compared with open surgery. Conclusion: Minimally invasive and robotic techniques for oesophagectomy are associated with reduced perioperative morbidity and duration of hospital stay, with no compromise of oncological outcomes but no improvement in perioperative mortality.

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“…The review identified 98 studies 6,7,34–129 comparing surgical approaches for oesophagectomy, involving 32 315 patients ( Fig . 1 ).…”

Section: Resultsmentioning

confidence: 99%

Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis

et al. 2020

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“…As a result, the advent of minimally invasive surgery, including laparoscopy, thoracoscopy and, more recently, robotic‐assisted surgery, has gained attention in an effort to minimize morbidity . Indeed, it seems that minimally invasive esophagectomy can be associated with some advantages over conventional surgery, especially in terms of diminished blood loss, lower general morbidity and shorter postoperative hospitalization …”

Section: Discussionmentioning

confidence: 99%

Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

Guerra

Vegni

Gia

et al. 2018

Robotics Computer Surgery

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“…In particular, there is increasing evidence that one-lung ventilation might generate a number of anatomic changes in both dependent and non-dependent lungs. Their effects are similar to a compartmental inflammatory injury [ 27 , 28 , 29 , 30 , 31 , 32 , 33 ] that may impact the immunological response.…”

Section: Discussionmentioning

confidence: 99%

Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy

Mineo

Sellitri

Vanni

et al. 2017

IJMS

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Abstract:Background: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia. Methods: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery. Results:The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure (p = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 (p = 0.03), 7 (p = 0.04), and 14 (p = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) (p = 0.04). The median hospital stay was 3.0 vs. 3.7 (p = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay. Conclusions: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.

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Comparison of postoperative immune function in patients with thoracic esophageal cancer after video-assisted thoracoscopic surgery or conventional open esophagectomy

Abstract: Patients may experience less postoperative immune suppression after VATS than after conventional open esophagectomy, and they may recover preoperative immune function more quickly.

Cited by 15 publications

References 27 publications

Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis

Minimally invasive techniques for transthoracic oesophagectomy for oesophageal cancer: systematic review and network meta-analysis

Early experience with totally robotic esophagectomy for malignancy. Surgical and oncological outcomes

Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy

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