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Surgical Endoscopy

, Volume 30, Issue 9, pp 3873–3881 | Cite as

Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes

  • Wei Guo
  • Xiao Ma
  • Su Yang
  • Xiaoli Zhu
  • Wei Qin
  • Jiaqing Xiang
  • Toni Lerut
  • Hecheng LiEmail author
Article

Abstract

Objectives

At present there is controversy regarding the optimal surgical method for esophageal cancer. Specifically, whether combined thoracoscopic-laparoscopic esophagectomy is superior to open esophagectomy with respect to the surgical wound, perioperative morbidities and mortality, and the overall survival rate is of great concern. This article aimed to compare thoracoscopic-laparoscopic esophagectomy versus open esophagectomy on the perioperative morbidities and long-term survival.

Methods

PubMed, Embase, and Google Scholar databases were searched for relevant studies comparing combined thoracoscopic-laparoscopic esophagectomy with open esophagectomy using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses standards. Odds ratios were extracted to give pooled estimates of the perioperative effect of the two surgical procedures. Hazard ratios were extracted to compare overall survival between the two surgical procedures.

Results

Thirteen studies involving 1549 patients were included in this meta-analysis. We found that patients that underwent combined thoracoscopic-laparoscopic esophagectomy had lower total complication rates (relative risk 1.20; 95 % CI 1.08–1.34; p = 0.0009), wound infection rates, pulmonary complications, and less intraoperative blood loss. Moreover, our study also showed combined thoracoscopic-laparoscopic esophagectomy did not compromise the 5-year survival rate (hazard risk 0.920; 95 % CI 0.720–1.176; p = 0.505) and even improved 2-year survival rate. The 30-day mortality and other common morbidities, including anastomotic leakage, anastomotic stricture, pulmonary infection, chylothorax, arrhythmia, or recurrent laryngeal nerve injury, were not significantly different between combined thoracoscopic-laparoscopic esophagectomy and traditional open esophagectomy (p > 0.05).

Conclusions

Combined thoracoscopic-laparoscopic esophagectomy is a feasible and reliable surgical procedure that can achieve uncompromising long-term survival rates and reduce perioperative complications.

Keywords

Minimally invasive surgery Esophageal cancer Video-assisted thoracoscopic surgery Laparoscopy Esophagectomy Meta-analysis 

Notes

Acknowledgments

We gratefully acknowledge the valuable cooperation of Toni Lerut (Department of Thoracic Surgery, University Hospital Gasthuisberg) and Ting Ye (Department of Thoracic Surgery, Fudan University Shanghai Cancer Center).

Funding

This work was supported by the Grant from the National Natural Science Foundation of China (81272608, 81102044).

Compliance with ethical standards

Disclosures

Wei Guo, Xiao Ma, Su Yang, Xiaoli Zhu, Wei Qin, Jiaqing Xiang, Toni Lerut, and Hecheng Li have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Wei Guo
    • 1
    • 2
  • Xiao Ma
    • 1
    • 2
  • Su Yang
    • 3
  • Xiaoli Zhu
    • 2
    • 4
  • Wei Qin
    • 5
  • Jiaqing Xiang
    • 1
    • 2
  • Toni Lerut
    • 6
  • Hecheng Li
    • 3
    Email author
  1. 1.Department of Thoracic SurgeryFudan University Shanghai Cancer Center (FUSCC)ShanghaiChina
  2. 2.Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
  3. 3.Department of Thoracic Surgery, Ruijin HospitalShanghai Jiaotong University School of MedicineShanghaiChina
  4. 4.Department of PathologyFudan University Shanghai Cancer Center (FUSCC)ShanghaiChina
  5. 5.School of StatisticRenmin University of ChinaBeijingChina
  6. 6.Department of Thoracic SurgeryUniversity Hospital GasthuisbergLouvainBelgium

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