Meta-Analysis
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2019; 11(11): 1081-1091
Published online Nov 15, 2019. doi: 10.4251/wjgo.v11.i11.1081
Efficacy of hybrid minimally invasive esophagectomy vs open esophagectomy for esophageal cancer: A meta-analysis
Jiao Yang, Ling Chen, Ke Ge, Jian-Le Yang
Jiao Yang, Ling Chen, Ke Ge, Jian-Le Yang, Department of Infectious Diseases, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310013, Zhejiang Province, China
Author contributions: Yang J contributed to idea conception, literature search, data extraction, and manuscript writing and approval; Chen L contributed to data extraction, data confirmation, and manuscript writing and approval; Ge K and Yang JL contributed to data confirmation and manuscript writing and approval.
Conflict-of-interest statement: None 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 which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jiao Yang, MD, Doctor, Department of Infectious Diseases, Zhejiang Hospital, 12 Lingyin Road, Hangzhou 310000, Zhejiang Province, China. yangjiao19890912@163.com
Telephone: +86-13516812609 Fax: +86-571-87980175
Received: February 25, 2019
Peer-review started: February 26, 2019
First decision: April 16, 2019
Revised: May 13, 2019
Accepted: August 18, 2019
Article in press: August 19, 2019
Published online: November 15, 2019
Processing time: 264 Days and 23.1 Hours
Abstract
BACKGROUND

The first line treatment regimen for esophageal cancer is still surgical resection and the choice of surgical scheme depends on surgeon. Now the efficacy comparison of hybrid minimally invasive esophagectomy (HMIE) and open esophagectomy (OE) is still controversial.

AIM

To compare the perioperative and postoperative outcomes of HMIE and OE in patients with esophageal cancer.

METHODS

PubMed, EMBASE, and Cochrane Library databases were searched for related articles. The odds ratio (OR) or standard mean difference (SMD) with a 95% confidence interval (CI) was used to evaluate the effectiveness of HMIE and OE.

RESULTS

Seventeen studies including a total of 2397 patients were selected. HMIE was significantly associated with less blood loss (SMD = -0.43, 95%CI: -0.66, -0.20; P = 0.0002) and lower incidence of pulmonary complications (OR = 0.72, 95%CI: 0.57, 0.90; P = 0.004). No significant differences were seen in the lymph node yield (SMD = 0.11, 95%CI: -0.08, 0.30; P = 0.26), operation time (SMD = 0.24, 95%CI: -0.14, 0.61; P = 0.22), total complications rate (OR = 0.68, 95%CI: 0.46, 0.99; P = 0.05), cardiac complication rate (OR = 0.91, 95%CI: 0.62, 1.34; P = 0.64), anastomotic leak rate (OR = 0.95, 95%CI: 0.67, 1.35; P = 0.78), duration of intensive care unit stay (SMD = -0.01, 95%CI: -0.21, 0.19; P = 0.93), duration of hospital stay (SMD = -0.13, 95%CI: -0.28, 0.01; P = 0.08), and total mortality rates (OR = 0.70, 95%CI: 0.47, 1.06; P = 0.09) between the two treatment groups.

CONCLUSION

Compared with the OE, HMIE shows less blood loss and pulmonary complications. However, further studies are necessary to evaluate the long-term oncologic outcomes of HMIE.

Keywords: Hybrid minimally invasive esophagectomy; Open esophagectomy; Esophageal cancer

Core tip: In this meta-analysis, hybrid minimally invasive esophagectomy (HMIE) was found to be associated with less blood loss and lower incidence of pulmonary complications compared to conventional open esophagectomy (OE). In the subgroup analysis, patients with HMIE using laparoscopic gastric mobilization-thoracotomy presented less blood loss, shorter hospital stay, lower incidence of total and pulmonary complications than those with OE. No significant difference was observed between the two groups in mortality. In conclusion, our study is the first meta-analysis confirming the priority of HMIE to OE.