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

Abstract

BackgroundCompared 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).ObjectiveThe objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM).Data SourcesSources 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 SelectionData of randomized and non-randomized clinical trials related to MIO versus OE were included.InterventionsEligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.Study Appraisal and Synthesis MethodsFixed 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.ResultsA 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).LimitationMost of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.ConclusionsMinimally 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.

Diaphragmatic herniation following esophagogastric resectional surgery: an increasing problem with minimally invasive techniques?

“…The colon can be observed entering the hernia (1). After the colon is reduced, the left lobe of the liver is mobilized to free the diaphragm anteriorly (2). The view after reduction shows the gastric conduit and the aorta (3).…”

“…Advantages of minimal access approaches to the esophagus include a lower risk of postoperative chest infection, shorter length of stay, quicker return to work and post-operative recovery [2][3][4]. There are cited disadvantages, including higher rates of gastric conduit necrosis and anastomotic leak [5,6].…”

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

“…Zhou et al [24] reported significant decrease in the morbidity of arrhythmia and pulmonary embolism in MIO group. Corresponding to this, (see Table 3), we found MIO to be superior to OE in reducing morbidity of system complications, according to the pooled OR = 0.777.…”

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

“…So far, only four randomized studies have done their jobs and that is the reason why the majority of the existed meta-analyses were based on retrospective studies. Among those meta-analyses that had been done before us: Sgourakis et al8 compared postoperative outcomes and survival between MIE and OE and revealed that both groups have the same in-hospital results and prognosis; Nagpal et al9 analyzed postoperative outcomes, including the 30-day mortality and anastomotic leakage of MIE and OE and revealed that there was no significant difference in the mortality; Zhou et al10,11 compared anastomotic leakage and in-hospital mortality between the two groups, and the outcome showed that MIE has superiority over OE as the former could reduce the in-hospital mortality rate; however, there was no evidence that MIE could decrease the anastomotic leakage; and Guo et al12 indicated that MIE can achieve significant long-term survival rates and reduce perioperative complications.…”