ANU Medical School, The Australian National University, Canberra, ACT, Australia.
Division of Surgery, The Canberra Hospital, Garran, ACT, Australia.
Eur J Surg Oncol. 2019 Jun;45(6):941-949. doi: 10.1016/j.ejso.2018.11.017. Epub 2018 Nov 24.
The effectiveness of minimally invasive oesophagectomy (MIO) compared to open oesophagectomy (OO) remains controversial. Various techniques for performing MIO are currently used, but the evidence for them is lacking. The objective of this meta-analysis was to compare the safety, efficacy and oncological outcomes of McKeown's minimally invasive oesophagectomy (McKeown's-MIO) to OO.
PubMed, Embase and Cochrane Library databases were searched up to December 2016 for relevant articles comparing McKeown's-MIO to OO. As no randomised control trials (RCTs) currently exist, only cohort and case control studies were included. Fixed or random-effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for binary outcomes, and hazard ratios (HRs) for time-to-event outcomes. Heterogeneity among studies were evaluated using I statistics.
Four studies, which consisted a total of 573 patients, were included in the meta-analysis. In comparison to patients undergoing OO, those who were treated with McKeown's-MIO had a reduced incidence of pneumonia and total respiratory complications, however, there were no statistically significant differences for other measures of safety such as RLN palsy and anastomotic leak. In terms of efficacy data, MIO had significantly less blood loss and a shorter duration of hospital stay but a longer operating time. Lymph node retrieval trended towards favouring McKeown's-MIO, but was not statistically significant. There was insufficient data to report on other oncological outcomes.
McKeown's-MIO is a safe and effective procedure that has comparable outcomes to OO. However, RCTs with large sample sizes are needed to confirm these results.
微创食管切除术（MIO）与开放食管切除术（OO）的疗效仍存在争议。目前有多种方法可以进行 MIO，但缺乏相关证据。本荟萃分析的目的是比较 McKeown 微创食管切除术（McKeown's-MIO）与 OO 的安全性、疗效和肿瘤学结果。
检索 PubMed、Embase 和 Cochrane Library 数据库，查找截至 2016 年 12 月比较 McKeown's-MIO 与 OO 的相关文章。由于目前尚无随机对照试验（RCT），仅纳入队列和病例对照研究。使用固定或随机效应模型计算二分类结局的汇总优势比（OR）或相对风险（RR），以及时间事件结局的风险比（HR）。使用 I ² 统计量评估研究间的异质性。
纳入了 4 项研究，共 573 例患者，对其进行了荟萃分析。与接受 OO 的患者相比，接受 McKeown's-MIO 治疗的患者肺炎和总呼吸系统并发症的发生率降低，但其他安全性指标如 RLN 麻痹和吻合口漏的发生率无统计学差异。在疗效数据方面，MIO 术中出血量较少，住院时间较短，但手术时间较长。淋巴结检出率倾向于 McKeown's-MIO，但无统计学意义。没有足够的数据报告其他肿瘤学结果。
McKeown's-MIO 是一种安全有效的手术方法，其结果与 OO 相当。然而，需要进行更大样本量的 RCT 来证实这些结果。
