Meta-Analysis
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World J Gastroenterol. Aug 7, 2014; 20(29): 10183-10192
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.10183
Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: A meta-analysis
Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang
Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wei MT and Wang ZQ designed the research; Wang ZQ provided supervision; Wei MT and He YZ performed the research; Deng XB and Yang TH performed a literature search and collected the data; Wei MT and Zhang YC analyzed the data and wrote the paper.
Supported by National Natural Science Foundation of China, No. 81172373
Correspondence to: Zi-Qiang Wang, Professor, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu 610041, Sichuan Province, China. wangzqzyh@163.com
Telephone: +86-28-85422480 Fax: +86-28-81654035
Received: November 20, 2013
Revised: February 13, 2014
Accepted: March 5, 2014
Published online: August 7, 2014
Abstract

AIM: To compare the efficacy and safety of the transthoracic and transhiatal approaches for cancer of the esophagogastric junction.

METHODS: An electronic and manual search of the literature was conducted in PubMed, EmBase and the Cochrane Library for articles published between March 1998 and January 2013. The pooled data included the following parameters: duration of surgical time, blood loss, dissected lymph nodes, hospital stay time, anastomotic leakage, pulmonary complications, cardiovascular complications, 30-d hospital mortality, and long-term survival. Sensitivity analysis was performed by excluding single studies.

RESULTS: Eight studies including 1155 patients with cancer of the esophagogastric junction, with 639 patients in the transthoracic group and 516 in the transhiatal group, were pooled for this study. There were no significant differences between two groups concerning surgical time, blood loss, anastomotic leakage, or cardiovascular complications. Dissected lymph nodes also showed no significant differences between two groups in randomized controlled trials (RCTs) and non-RCTs. However, we did observe a shorter hospital stay (WMD = 1.92, 95%CI: 1.63-2.22, P < 0.00001), lower 30-d hospital mortality (OR = 3.21, 95%CI: 1.13-9.12, P = 0.03), and decreased pulmonary complications (OR = 2.95, 95%CI: 1.95-4.45, P < 0.00001) in the transhiatal group. For overall survival, a potential survival benefit was achieved for type III tumors with the transhiatal approach.

CONCLUSION: The transhiatal approach for cancers of the esophagogastric junction, especially types III, should be recommended, and its long-term outcome benefits should be further evaluated.

Keywords: Transthoracic surgery, Transhiatal surgery, Cancer of the esophagogastric junction, Meta-analysis

Core tip: Surgical resection is the optimum therapy for cancer of the esophagogastric junction, and the transthoracic and transhiatal approaches are the two major surgical approaches used worldwide. However, considerable debate exists on the superior benefits of the two approaches regarding their efficacy and safety. We conducted this meta-analysis to address the issue. The results indicated a shorter hospital stay, lower 30-d hospital mortality and decreased pulmonary complications with the transhiatal approach compared with the transthoracic approach. Moreover, a potential survival benefit was achieved for type III tumors using the transhiatal approach.