Short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy and minimally invasive transthoracic esophagectomy for esophageal cancer: A systematic review and meta-analysis
- VernacularTitle:充气式纵隔镜联合腹腔镜与微创经胸食管切除术治疗食管癌短期疗效及安全性的系统评价与Meta分析
- Author:
Keyong LI
1
;
Tao CHENG
1
;
Dacheng JIN
2
;
Zhibo YE
1
;
Changhao QUE
1
;
Yaping WANG
1
;
Qizhou BAI
3
Author Information
1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China
3. 1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China 2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China
- Publication Type:Journal Article
- Keywords:
Inflatable mediastinoscopy;
minimally invasive esophagectomy;
esophageal neoplasms;
systematic review/meta-analysis
- From:
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
2024;31(07):1027-1034
- CountryChina
- Language:Chinese
-
Abstract:
Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive transthoracic esophagectomy (MITE) in the treatment of esophageal cancer. Methods The Cochrane Library, EMbase, PubMed, Wanfang Database, VIP, and CNKI were searched. Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4. Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale (NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook. Results A total of 14 studies (12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included, comprising 1 163 patients, with 525 in the IVMTE group and 638 in the MITE group. The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time [MD=−60.42, 95%CI (−83.78, −37.07), P<0.001] and postoperative hospital stay [MD=−2.44, 95%CI (−2.93, −1.94), P<0.01] compared to the MITE group. Moreover, intraoperative blood loss [MD=−34.67, 95%CI (−59.11, −10.23), P=0.005], three-day postoperative drainage [MD=−286.66, 95%CI (−469.93, −103.40), P=0.002], incidence of postoperative pulmonary infection [OR=0.38, 95%CI (0.26, 0.56), P<0.001], lung leakage rate [OR=0.12, 95% CI (0.02, 0.63), P=0.01] and overall complication rate [MD=0.41, 95%CI (0.22, 0.75), P=0.004] were all lower in the IVMTE group compared to those in the MITE group. However, the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=−3.52, 95%CI (−6.36, –0.68), P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78, 95%CI (1.22, 2.60), P=0.003]. No significant difference was observed between both methods concerning anastomotic fistula. Conclusion Compared to MITE, IVMTE has advantages such as shorter operation time, less intraoperative blood loss, shorter hospital stay, less postoperative drainage within 3 days, and a lower incidence of pulmonary complications. In terms of laryngeal recurrent nerve injury and lymphatic dissection, MITE operation offers more benefits.
