Medical Office Administration, The General Hospital of Western Theater Command, Chengdu, China.
Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, China.
J Invest Surg. 2021 Sep;34(9):963-973. doi: 10.1080/08941939.2020.1725189. Epub 2020 Feb 9.
Transthoracic hybrid minimally invasive esophagectomy (HMIE) is frequently performed in patients with esophageal cancer. However, no conclusive benefit has been defined for HMIE compared with open esophagectomy (OE) or totally MIE (TMIE). The aim of this meta-analysis is to evaluate the effectiveness of HMIE compared with OE and TMIE.
PubMed, Embase (via OVID) and Cochrane databases were comprehensively searched for relevant studies up to January 2019. Studies comparing the efficacy of transthoracic HMIE with OE or TMIE were included in this meta-analysis.
Twenty-nine relevant studies comprising 3994 patients were identified and included in the analysis of HMIE OE. HMIE decreased the incidence of postoperative total morbidity (OR = 0.66, 95% CI 0.55 to 0.80, = 0.00), pneumonia (OR = 0.55, 95% CI 0.45 to 0.66, = 0.00), in-hospital mortality (OR = 0.54, 95% CI 0.36 to 0.83, = 0.01), duration of hospitalization (SMD=-1.03, 95% CI -1.73 to -0.33, = 0.00) and the estimated intraoperative blood loss (SMD=-1.01, 95% CI -1.62 to -0.40, = 0.00) compared with OE. Twenty-one relevant studies comprising 3007 patients were identified and included in the analysis of HMIE TMIE. HMIE increased estimated intraoperative blood loss [standardized mean difference (SMD) = 1.02, 95% CI 0.45 to 1.58, = 0.00] and the incidence of postoperative pneumonia (OR = 1.69, 95% CI 1.26 to 2.26, = 0.00) compared with TMIE. No statistical differences were observed for other surgical outcomes.
In our opinion, HMIE is a promising surgical technique. But further RCTs are still needed to confirm the advantages and disadvantages of HMIE mentioned above.
经胸微创食管切除术（HMIE）常用于治疗食管癌患者。然而，与开放食管切除术（OE）或全微创食管切除术（TMIE）相比，HMIE 并未显示出明确的优势。本荟萃分析旨在评估 HMIE 与 OE 和 TMIE 的疗效。
全面检索了 PubMed、Embase（通过 OVID）和 Cochrane 数据库，截至 2019 年 1 月，纳入比较经胸 HMIE 与 OE 或 TMIE 疗效的研究。
共纳入 29 项研究，共 3994 例患者，分析 HMIE 与 OE 的疗效。HMIE 降低了术后总并发症发生率（OR = 0.66，95%CI 0.55 至 0.80， = 0.00）、肺炎发生率（OR = 0.55，95%CI 0.45 至 0.66， = 0.00）、院内死亡率（OR = 0.54，95%CI 0.36 至 0.83， = 0.01）、住院时间（SMD =-1.03，95%CI -1.73 至 -0.33， = 0.00）和术中估计出血量（SMD =-1.01，95%CI -1.62 至 -0.40， = 0.00），与 OE 相比。纳入 21 项研究，共 3007 例患者，分析 HMIE 与 TMIE 的疗效。与 TMIE 相比，HMIE 增加了术中估计出血量（标准化均数差（SMD）= 1.02，95%CI 0.45 至 1.58， = 0.00）和术后肺炎发生率（OR = 1.69，95%CI 1.26 至 2.26， = 0.00）。其他手术结果无统计学差异。
在我们看来，HMIE 是一种有前途的手术技术。但仍需要进一步的 RCT 来证实上述 HMIE 的优缺点。
