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Review
. 2014 Aug 7;20(29):10183-92.
doi: 10.3748/wjg.v20.i29.10183.

Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: a meta-analysis

Ming-Tian Wei  1 , Yuan-Chuan Zhang  1 , Xiang-Bing Deng  1 , Ting-Han Yang  1 , Ya-Zhou He  1 , Zi-Qiang Wang  1
Affiliations
Review

Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: a meta-analysis

Ming-Tian Wei et al. World J Gastroenterol. .

Abstract

Aim: To compare the efficacy and safety of the transthoracic and transhiatal approaches for cancer of the esophagogastric junction.

Methods: An electronic and manual search of the literature was conducted in PubMed, EmBase and the Cochrane Library for articles published between March 1998 and January 2013. The pooled data included the following parameters: duration of surgical time, blood loss, dissected lymph nodes, hospital stay time, anastomotic leakage, pulmonary complications, cardiovascular complications, 30-d hospital mortality, and long-term survival. Sensitivity analysis was performed by excluding single studies.

Results: Eight studies including 1155 patients with cancer of the esophagogastric junction, with 639 patients in the transthoracic group and 516 in the transhiatal group, were pooled for this study. There were no significant differences between two groups concerning surgical time, blood loss, anastomotic leakage, or cardiovascular complications. Dissected lymph nodes also showed no significant differences between two groups in randomized controlled trials (RCTs) and non-RCTs. However, we did observe a shorter hospital stay (WMD = 1.92, 95%CI: 1.63-2.22, P < 0.00001), lower 30-d hospital mortality (OR = 3.21, 95%CI: 1.13-9.12, P = 0.03), and decreased pulmonary complications (OR = 2.95, 95%CI: 1.95-4.45, P < 0.00001) in the transhiatal group. For overall survival, a potential survival benefit was achieved for type III tumors with the transhiatal approach.

Conclusion: The transhiatal approach for cancers of the esophagogastric junction, especially types III, should be recommended, and its long-term outcome benefits should be further evaluated.

Keywords: Cancer of the esophagogastric junction; Meta-analysis; Transhiatal surgery; Transthoracic surgery.

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Figures

Figure 1
Figure 1
Flow diagram of the meta-analysis study selection process.
Figure 2
Figure 2
Forest plot of surgery-related data, including the duration of surgical time (A), blood loss (B), hospital stay time (C) and hospital deaths (D), in the transthoracic group vs transhiatal group of cancers of the esophagogastric junction. IV: Inverse variance; M-H: Mantel-Haenszel.
Figure 3
Figure 3
Forest plot of dissected lymph nodes in randomized controlled trials (A) and non-randomized controlled trials (B) for the transthoracic group vs transhiatal group of cancers of the esophagogastric junction. IV: Inverse variance; M-H: Mantel-Haenszel; CI: Confidence interval.
Figure 4
Figure 4
Forest plot of complications, including anastomotic leak (A), pulmonary complications (B) and cardiovascular complications (C), in the transthoracic group vs transhiatal group of cancers of the esophagogastric junction. M-H: Mantel-Haenszel; CI: Confidence interval.
Figure 5
Figure 5
Forest plot of overall survival in the transthoracic group vs transhiatal group of cancers of the esophagogastric junction. A: All Siewert types; B: Siewert I; C: Siewert II; D: Siewert III. IV: Inverse variance.
See this image and copyright information in PMC

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