Zhou Can, Ma Gang, Li Xiao, Li Juan, Yan Yu, Liu Peijun, He Jianjun, Ren Yu
Department of Breast Surgery, the First Affiliated Hospital, Xi'an Jiaotong University, 277 Yanta Western Rd, Xi'an, 710061, Shaanxi Province, China.
Department of Translational Medicine Center, the First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, 710061, Shaanxi Province, China.
World J Surg Oncol. 2015 Sep 4;13:269. doi: 10.1186/s12957-015-0661-z.
Compared with open esophagectomy (OE), minimally invasive esophagectomy (MIE) proves to have clear benefits in reducing the risk of pulmonary complications for patients with resectable esophageal cancer. The objectives of our study were to explore the superiority of MIE in reducing the occurrence of anastomotic leakages (ALs) when compared to OE.
A systematic review and meta-analysis was performed to assess the superiority of MIE on the occurrence of ALs over OE, by searching many sources (through December, 2014) such as Medline, Embase, Wiley Online Library, and Cochrane Library. Fixed-effects model was used to calculate summary odds ratios (ORs) to quantify associations between OE and MIE groups. Cochran's Q and I(2) statistics were used to evaluate heterogeneity among studies.
Among a total of 43 studies involving 5537 patients included in the meta-analysis, 2527 (45.6%) cases underwent MIE and 3010 (54.4%) cases underwent OE. Compared to patients undergoing OE, patients undergoing MIE did not have statistical significance in reduced occurrence of ALs (OR = 0.97, 95% CI = 0.80-1.17). Insignificant reduced occurrence of ALs was not associated with anastomotic location (OR = 0.90, 95% CI = 0.71-1.13) or anastomotic procedure (OR = 1.02, 95% CI = 0.79-1.30).
More proofs are needed to clarify the strengths or weaknesses of MIE in preventing anastomotic leakages after esophagectomy for cancer. A largely randomized, controlled trial should be undertaken to resolve this contentious issue urgently.
与开放食管切除术（OE）相比，微创食管切除术（MIE）在降低可切除食管癌患者肺部并发症风险方面具有明显优势。我们研究的目的是探讨与OE相比，MIE在减少吻合口漏（AL）发生方面的优越性。
通过检索多个来源（截至2014年12月），如Medline、Embase、Wiley在线图书馆和Cochrane图书馆，进行系统评价和荟萃分析，以评估MIE在AL发生方面相对于OE的优越性。采用固定效应模型计算汇总比值比（OR），以量化OE组和MIE组之间的关联。使用Cochran's Q和I²统计量评估研究间的异质性。
在荟萃分析纳入的总共43项研究、5537例患者中，2527例（45.6%）接受了MIE，3010例（54.4%）接受了OE。与接受OE的患者相比，接受MIE的患者在减少AL发生方面无统计学意义（OR = 0.97，95%CI = 0.80 - 1.17）。AL发生率的显著降低与吻合位置（OR = 0.90，95%CI = 0.71 - 1.13）或吻合操作（OR = 1.02，95%CI = 0.79 - 1.30）无关。
需要更多证据来阐明MIE在食管癌切除术后预防吻合口漏方面的优缺点。应尽快开展一项大规模随机对照试验来解决这一有争议的问题。
