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Novel Mediastinoscope-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Minimally invasive surgery is an expanding field of surgery that has replaced many open surgical techniques. Surgery remains a cornerstone in the treatment of esophageal cancer, yet it is still associated with significant morbidity and technical difficulties. Mediastinoscope-assisted esophagectomy is a promising technique that aims to decrease the surgical burden and enhance recovery.

Methods

PubMed, MEDLINE, and EMBASE databases were searched for publications on mediastinoscope-assisted esophagectomies for esophageal cancer. The primary endpoint was a postoperative anastomotic leak, while secondary endpoints were assessment of harvested lymph nodes (LNs), blood loss, chyle leak, hospital length of stay (LOS), operative (OR) time, pneumonia, wound infection, mortality, and microscopic positive margin (R1). The pooled event rate (PER) and pooled mean were calculated for binary and continuous outcomes respectively.

Results

Twenty-six out of the 2274 searched studies were included. The pooled event rate (PER) for anastomotic leak was 0.145 (0.1144; 0.1828). The PERs for chyle leak, recurrent laryngeal nerve injury/hoarseness, postoperative pneumonia, wound infection, early mortality, postoperative morbidity, and microscopically positive (R1) resection margins were 0.027, 0.185, 0.09, 0.083, 0.020, 0.378, and 0.037 respectively. The pooled means for blood loss, hospital stay, operative time, number of total harvested LNs, and number of harvested thoracic LNs were 159.209, 15.187, 311.116, 23.379, and 15.458 respectively.

Conclusions

Mediastinoscopic esophagectomy is a promising minimally invasive technique, avoiding thoracotomy, patient repositioning, and lung manipulation; thus allowing for shorter surgery, decreased blood loss, and decreased postoperative morbidity. It can also be reliable in terms of oncological safety and LN dissection.

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Author notes

  1. Anas Dabsha, Ismail A. M. H. Elkharbotly and Mohamed Rahouma have contributed equally to this work.

Authors and Affiliations

  1. Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA

    Anas Dabsha MD, MSc, Mohammad Yaghmour, Sherif Khairallah MD, MSc, Yomna M. Esmail, Shon Shmushkevich BS, Mohamed Hossny MD, Amr Rizk MD, MSc, Amgad Ishak, Jessica Wright BS & Mohamed Rahouma MD, MSc, MS

  2. Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt

    Anas Dabsha MD, MSc, Ismail A. M. H. Elkharbotly MD, MSc, Sherif Khairallah MD, MSc, Amr Rizk MD, MSc, Abdelrahman Mohamed MD, MSc & Mohamed Rahouma MD, MSc, MS

  3. General Surgery Department, Newham University Hospital, London, UK

    Ismail A. M. H. Elkharbotly MD, MSc

  4. General Surgery Department, Kasr Al-ainy School of Medicine, Cairo University, Cairo, Egypt

    Fady Badie MD, MSc

  5. El Ruwaisat Family Medical Center, Sharm Elsheikh, Egypt

    Amr Badr MD

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Dabsha, A., Elkharbotly, I.A.M.H., Yaghmour, M. et al. Novel Mediastinoscope-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 30, 4030–4039 (2023). https://doi.org/10.1245/s10434-023-13264-2

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