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

Abstract

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.

Robotic Esophagectomy. A Systematic Review with Meta-Analysis of Clinical Outcomes

“…The possible explanation of these better oncologic results could lay in the magnification of the images and in the finer dissection movements properly related to the robotic technology. Considering the current literature, these results are completely in accordance with the previous network meta-analysis by Siaw-Acheampong et al [70], confirming the advantages of the robotic approach over open technique. On the contrary, no disadvantages were associated with the robotic surgery, except for operative time (longer in the robotic group, p < 0.0001), but with no association with non-surgical postoperative complications.…”

“…More recently, Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) was introduced as an alternative minimally invasive method which may allow improved view of thoracic structures and increased precision [ 69 ]. Nevertheless, the presumed advantages of the robotic surgery are still under debate [ 69 , 70 , 71 ]. In this setting, three meta-analysis tried to assess if the robotic approach could be considered the best treatment to the esophageal cancer [ 70 , 71 , 72 ].…”

“…Nevertheless, the presumed advantages of the robotic surgery are still under debate [ 69 , 70 , 71 ]. In this setting, three meta-analysis tried to assess if the robotic approach could be considered the best treatment to the esophageal cancer [ 70 , 71 , 72 ]. In a network meta-analysis on 98 studies and 32,315 patients, Siaw-Acheampong et al [ 70 ] compared all combinations of open, laparoscopic and robotic approaches to transthoracic esophagectomy.…”

“…In this setting, three meta-analysis tried to assess if the robotic approach could be considered the best treatment to the esophageal cancer [ 70 , 71 , 72 ]. In a network meta-analysis on 98 studies and 32,315 patients, Siaw-Acheampong et al [ 70 ] compared all combinations of open, laparoscopic and robotic approaches to transthoracic esophagectomy. Their results demonstrated that compared with open surgery, both laparoscopic and robotic approaches were associated with less blood loss, significantly lower rates of pulmonary complications, shorter hospital stay and higher mean of harvested nodes, concluding that minimally invasive approaches were related with better postoperative outcomes with no compromise in oncologic results.…”

Comparison of Local Recurrence Patterns of Postoperative Radiotherapy with Surgery Alone for Esophageal Carcinoma Patients

“…At present, the overall 5-year survival rate of esophageal carcinoma is 45.7% [1]. Despite recent advances in minimally invasive oesophagectomy [2], there was no significant improvement in survival. The main treatment failure causes after surgery were local recurrence and distant metastasis.…”