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Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis

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Abstract

Introduction

Open esophagectomy for cancer is a major oncological procedure, associated with significant morbidity and mortality. Recently, thoracoscopic procedures have offered a potentially advantageous alternative because of less operative trauma compared with thoracotomy. The aim of this study was to utilize meta-analysis to compare outcomes of open esophagectomy with those of minimally invasive esophagectomy (MIE) and hybrid minimally invasive esophagectomy (HMIE).

Methods

Literature search was performed using Medline, Embase, Cochrane Library, and Google Scholar databases for comparative studies assessing different techniques of esophagectomy. A random-effects model was used for meta-analysis, and heterogeneity was assessed. Primary outcomes of interest were 30-day mortality and anastomotic leak. Secondary outcomes included operative outcomes, other postoperative outcomes, and oncological outcomes in terms of lymph nodes retrieved.

Results

A total of 12 studies were included in the analysis. Studies included a total of 672 patients for MIE and HMIE, and 612 for open esophagectomy. There was no significant difference in 30-day mortality; however, MIE had lower blood loss, shorter hospital stay, and reduced total morbidity and respiratory complications. For all other outcomes, there was no significant difference between the two groups.

Conclusion

Minimally invasive esophagectomy is a safe alternative to the open technique. Patients undergoing MIE may benefit from shorter hospital stay, and lower respiratory complications and total morbidity compared with open esophagectomy. Multicenter, prospective large randomized controlled trials are required to confirm these findings in order to base practice on sound clinical evidence.

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Disclosures

Mr. Nagpal, Mr. Ahmed, Mr. Vats, Mr. Yakoub, Mr. James, Mr. Ashrafian, Dr. Darzi, Dr. Moorthy, and Dr. Athanasiou have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. Imperial College London, London, UK

    Kamal Nagpal, Kamran Ahmed, Amit Vats, Danny Yakoub, David James, Hutan Ashrafian & Ara Darzi

  2. Regional Oesophageal Unit, Imperial College London, London, UK

    Krishna Moorthy

  3. Department of Cardiothoracic Surgery, Imperial College London, London, UK

    Thanos Athanasiou

  4. Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor, QEQM Building, St. Mary’s Hospital Campus, Praed Street, London, W2 1NY, UK

    Kamal Nagpal

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  1. Kamal Nagpal
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  2. Kamran Ahmed
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  3. Amit Vats
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  4. Danny Yakoub
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  5. David James
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  6. Hutan Ashrafian
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  7. Ara Darzi
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  8. Krishna Moorthy
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  9. Thanos Athanasiou
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Corresponding author

Correspondence to Kamal Nagpal.

Additional information

This work has been sponsored by Elision Health Limited.

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Nagpal, K., Ahmed, K., Vats, A. et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24, 1621–1629 (2010). https://doi.org/10.1007/s00464-009-0822-7

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  • DOI: https://doi.org/10.1007/s00464-009-0822-7

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