Abstract
Background
A meta-analysis of the current literature was performed to compare the perioperative outcome measures and oncological impact between minimally invasive and open esophagectomy.
Methods
Using the electronic databases Medline, Embase, Pubmed and the Cochrane Library, we performed a meta-analysis pooling the effects of outcomes of 1,008 patients enrolled into eight comparative studies, using classic and modern meta-analytic methods.
Results
Two comparisons were considered for this systematic review: (I) open thoracotomy vs. VATS/laparoscopy esophagectomy and (II) open thoracotomy vs. VATS esophagectomy. In comparison I: both procedures report equally comparable outcomes (removed lymph nodes, 30-day mortality, 3-year survival) with the exception of overall morbidity (P = 0.038; in favor of the MIE arm) and anastomotic stricture (P < 0.001; in favor of the open thoracotomy arm). In comparison II: No differences were noted between treatment arms concerning postoperative outcomes and survival.
Conclusions
In summary, both arms were comparable with regard to perioperative results and prognosis. Further prospective comparative or randomized-controlled trials focusing on the oncological impact of MIE are needed.
Similar content being viewed by others
References
Orringer MB. Substernal gastric bypass of the excluded thoracic esophagus for palliation of esophageal carcinoma. J Thorac Cardiovasc Surg. 1975;70:836.
Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med. 1998;339:1979–1984.
Luketich JD, Fernando HC, Christie NA, et al. Outcomes after minimally invasive esophagomyotomy. Ann Thorac Surg. 2001;72:1909–1912, discussion 1912–1913.
Stein H, Siewert J. Improved prognosis of resected esophageal cancer. World J Surg. 2004;28:520–525.
Orringer MB, Marshall B, Iannettoni MD. Transhiatal esophagectomy: clinical experience and refinements. Ann Surg. 1999;230:392–400.
Wu P, Posner M. The role of surgery in the management of oesophageal cancer. Lancet Oncol. 2003;4:481–488.
Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245:232–240.
Braghetto I, Csendes A, Cardemil G, et al. Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival. Surg Endosc. 2006;20:1681–1686.
Nguyen NT, Follette DM, Wolfe BM, et al. Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg. 2000;135:920–925.
Law S, Fok M, Chu KM, Wong J. Thoracoscopic esophagectomy for esophageal cancer. Surgery. 1997;122:8–14.
Kunisaki C, Hatori S, Imada T, et al. Video-assisted thoracoscopic esophagectomy with a voice-controlled robot: the AESOP system. Surg Laparosc Endosc Percutan Tech. 2004;14:323–327.
Taguchi S, Osugi H, Higashino M, et al. Comparison of three-field esophagectomy for esophageal cancer incorporating open or thoracoscopic thoracotomy. Surg Endosc. 2003;17:1445–1450.
Morris LG, Tran TN, DeLacure MD. Early experience with minimally invasive esophagectomy in head and neck surgical patients. Otolaryngol Head Neck Surg. 2007;137:947–949.
Zingg U, McQuinn A, DiValentino D, et al. Minimally invasive versus open esophagectomy for patients with esophageal cancer. Ann Thorac Surg. 2009;87:911–919.
Bresadola V, Terrosu G, Cojutti A, et al. Laparoscopic versus open gastroplasty in esophagectomy for esophageal cancer: a comparative study. Surg Laparosc Endosc Percutan Tech. 2006;16:63–67.
Valentí V, Fares R, Reynolds N, et al. Open and laparoscopic transhiatal oesophagectomy for cancer of the oesophagus: analysis of resection margins and lymph nodes. Cir Esp. 2008;83:24–27.
Benzoni E, Terrosu G, Bresadola V, et al. A comparative study of the transhiatal laparoscopic approach versus laparoscopic gastric mobilisation and right open transthoracic esophagectomy for esophageal cancer management. J Gastrointestin Liver Dis. 2007;16:395–401.
Bernabe KQ, Bolton JS, Richardson WS. Laparoscopic hand-assisted versus open transhiatal esophagectomy: a case-control study. Surg Endosc. 2005;19:334–337.
Moher D, Cook DJ, Eastwood S, et al. Improving the quality of reports of meta-analyses of randomized controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet. 1999;354:1896–1900.
Mahid SS, Hornung CA, Minor KS, et al. Systematic reviews and meta-analysis for the surgeon scientist. Br J Surg. 2006;93:1315–1324.
Egger M, Smith GD, Altman DG. Systematic reviews in health care: meta-analysis in context. 2nd edn. London: BMJ Books; 2001.
Review Manager (RevMan) [computer program]. Version 4.2 for Windows. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2003.
Higgins JPT, Green S, eds. Cochrane handbook for systematic reviews of interventions 4.2.6 [updated September 2006]. In: The Cochrane Library, Issue 4, 2006, Chichester, UK: Wiley.
Zamora J, Abraira V, Muriel A, et al. Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol. 2006;6:31.
Rosenberg MS, Adams DC, Gurevitch J. MetaWin. Statistical software for meta-analysis. Version 2. Sunderland, Massachusetts: Sinauer Associates; 2000.
Van den Broek WT, Makay O, Berends FJ, et al. Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus. Surg Endosc. 2004;18:812–817. Erratum in: Surg Endosc 2004;18:1292.
Conflict of interest statement
The authors have no financial or personal relationships with persons or organisations that could inappropriately influence this work.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sgourakis, G., Gockel, I., Radtke, A. et al. Minimally Invasive Versus Open Esophagectomy: Meta-Analysis of Outcomes. Dig Dis Sci 55, 3031–3040 (2010). https://doi.org/10.1007/s10620-010-1153-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-010-1153-1