Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden.
Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Ann Surg. 2019 Dec;270(6):1005-1017. doi: 10.1097/SLA.0000000000003252.
Evaluate the existing literature comparing long-term survival after minimally invasive esophagectomy (MIE) and open esophagectomy (OE), and conduct a meta-analysis based on relevant studies.
It is unknown whether the choice between MIE and OE influences the long-term survival in esophageal cancer.
A systematic electronic search for articles was performed in Medline, Embase, Web of Science, and Cochrane Library for studies comparing long-term survival after MIE and OE. Additionally, an extensive hand-search was conducted. The I test and χ test were used to test for statistical heterogeneity. Publication bias and small-study effects were assessed using Egger test. A random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year mortality outcomes with adjustment for the covariates age, physical status, tumor stage, and neoadjuvant or adjuvant therapy. The results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs).
The review identified 55 relevant studies. Among all 14,592 patients, 7358 (50.4%) underwent MIE and 7234 (49.6%) underwent OE. The statistical heterogeneity was limited [I = 12%, 95% confidence interval (CI) 0%-41%, and χ = 0.26] and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Pooled analysis revealed 18% lower 5-year all-cause mortality after MIE compared with OE (HR 0.82, 95% CI 0.76-0.88). The meta-regression indicated no confounding.
The long-term survival after MIE compares well with OE and may even be better. Thus, MIE can be recommended as a standard surgical approach for esophageal cancer.
评估微创食管切除术（MIE）与开放食管切除术（OE）在长期生存方面的现有文献，并基于相关研究进行荟萃分析。
目前尚不清楚 MIE 和 OE 之间的选择是否会影响食管癌的长期生存。
系统检索 Medline、Embase、Web of Science 和 Cochrane Library 中比较 MIE 和 OE 后长期生存的文章。此外，还进行了广泛的手工检索。使用 I 检验和 χ 检验来检验统计异质性。使用 Egger 检验评估发表偏倚和小样本效应。对所有原因 5 年（主要结局）和 3 年死亡率以及疾病特异性 5 年和 3 年死亡率进行随机效应荟萃分析。对 5 年死亡率结果进行了荟萃回归，调整了年龄、身体状况、肿瘤分期以及新辅助或辅助治疗等协变量。结果以 95%置信区间（CI）的风险比（HR）表示。
综述共确定了 55 项相关研究。在所有 14592 名患者中，7358 名（50.4%）接受了 MIE，7234 名（49.6%）接受了 OE。统计异质性有限[I = 12%，95%CI 0%-41%，χ = 0.26]，漏斗图根据视觉和统计检验均呈对称（Egger 检验 = 0.32）。汇总分析显示，MIE 后 5 年全因死亡率比 OE 低 18%（HR 0.82，95%CI 0.76-0.88）。荟萃回归表明无混杂因素。
MIE 的长期生存效果与 OE 相当，甚至可能更好。因此，MIE 可以作为食管癌的标准手术方法推荐。
