Minimally invasive versus open esophagectomy: meta-analysis of outcomes

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.