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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Network meta-analysis of randomized controlled trials on esophagectomies in esophageal cancer: The superiority of minimally invasive surgery
Lajos Szakó, Dávid Németh, Nelli Farkas, Szabolcs Kiss, Réka Zsuzsa Dömötör, Marie Anne Engh, Péter Hegyi, Balint Eross, András Papp
Lajos Szakó, Nelli Farkas, Marie Anne Engh, Péter Hegyi, Institute of Translational Medicine, University of Pécs, Medical School, Pécs 7624, Hungary
Lajos Szakó, János Szentágothai Research Centre, University of Pécs, Medical School, Pécs 7624, Hungary
Dávid Németh, Réka Zsuzsa Dömötör, Institute for Translational Medicine, University of Pécs, Medical School, Pécs 7624, Hungary
Dávid Németh, Nelli Farkas, Institute of Bioanalysis, University of Pécs, Medical School, Pécs 7624, Hungary
Szabolcs Kiss, Insittute of Translational Medicine, University of Pécs, Medical School, Pécs 7624, Hungary
Szabolcs Kiss, Doctoral School of Clinical Medicine, University of Szeged, Medical School, Szeged 6720, Hungary
Péter Hegyi, First Department of Medicine, University of Szeged, Medical School, Szeged 6725, Hungary
Balint Eross, Institute of Translational Medicine, University of Pecs, Medical School, Pecs 7624, Hungary
András Papp, Department of Surgery, Clinical Center, University of Pécs, Medical School, Pécs 7624, Hungary
Author contributions: Szakó L conceptualized the work, contributed to establishment of the search key, selection strategy, data extraction, interpretation of the results, and writing of the manuscript; Németh D and Farkas N performed the bio-statistical analyses, and contributed to the interpretation of the results and writing of the manuscript; Kiss S helped was involved in the conceptualization, coordination of the work, and writing the manuscript; Dömötör RZ conceptualized, wrote, and critically appraised the manuscript; Engh MA was involved in the conceptualization, data extraction, risk of bias assessment, writing of the manuscript, and language revision of the manuscript; Hegyi P contributed to the conceptualization, interpretation of the results, critical appraisal, and writing of the manuscript; Erőss BM conceptualized the work, interpreted the results, critically appraised and wrote the manuscript; Papp A provided supervision, and was involved in the conceptualization, interpretation of the results, critical appraisal, and writing of the manuscript.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: András Papp, PhD, Associate Professor, Department of Surgery, Clinical Center, University of Pécs, Medical School, 13 Ifjúság útja, Pécs 7624, Hungary. papp.andras@pte.hu
Received: January 16, 2022
Peer-review started: January 16, 2022
First decision: April 12, 2022
Revised: April 26, 2022
Accepted: July 16, 2022
Article in press: July 16, 2022
Published online: August 14, 2022
ARTICLE HIGHLIGHTS
Research background
The differences considering esophagectomies as the most applied curative methodology in the case of esophageal cancer are not clearly described. Minimally invasive techniques have become more popular in the belief of their superiority, although objective evidence is missing.
Research motivation
Recent guidelines are not yet clear considering the usage of minimally invasive esophagectomies. The authors wanted to provide the most objective evidence available, considering the differences between every subtype of minimally invasive and open esophagectomies.
Research objectives
The authors aimed to find every randomized controlled trial (RCT) providing comparative information about at least two types of esophagectomies, and pool the results using NMA.
Research methods
After establishing our clinical question using the population, intervention, control, outcome (commonly known as (PICO) framework a systemic search was carried out using three different databases. The results of the search were pooled, duplications were removed, suitable studies were selected, from which the data extraction was carried out onto a data sheet. With the help of biostatisticians, a network meta-analysis was performed. The quality of the included studies was assessed, as well as the grade of evidence.
Research results
Eleven articles were included in our analysis, according to which the minimally invasive surgical technique was superior compared to the transthoracic open approach in terms of pulmonary infection, while transthoracic surgery took less time to perform than any other surgical technique.
Research conclusions
The authors conclude that minimally invasive surgical techniques should be performed, whenever possible, for resectable esophageal cancer.
Research perspectives
The conduction of additional RCTs evaluating the same problem would be welcomed, while we hope that our work will help clinicians in the decision-making of the selection of the right surgical technique.
