• Can Zhou, Li Zhang, Hua Wang, Xiaoxia Ma, Bohui Shi, Wuke Chen, Jianjun He, Ke Wang, Peijun Liu, and Yu Ren.
• Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
• Plos One. 2015 Jan 1; 10 (7): e0132889.

BackgroundCompared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM).ObjectiveThe objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM).Data SourcesSources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched.Study SelectionData of randomized and non-randomized clinical trials related to MIO versus OE were included.InterventionsEligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.Study Appraisal And Synthesis MethodsFixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran's Q and I2 statistics.ResultsA total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49).LimitationMost of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.ConclusionsMinimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.

22 keywords...

hide…