Ramjit Sinead E, Ashley Emmaline, Donlon Noel E, Weiss Andreas, Doyle Frank, Heskin Leonie
Department of Surgery, Trinity College Dublin, Dublin, Ireland.
Department of Surgery, Royal College Surgeons Ireland, Dublin, Ireland.
Dis Esophagus. 2022 Dec 14;35(12). doi: 10.1093/dote/doac025.
Traditionally, esophageal oncological resections have been performed via open approaches with well-documented levels of morbidity and mortality complicating the postoperative course. In contemporary terms, minimally invasive approaches have garnered sustained support in all areas of surgery, and there has been an exponential adaptation of this technology in upper GI surgery with the advent of laparoscopic and robotic techniques. The current literature, while growing, is inconsistent in reporting on the benefits of minimally invasive esophagectomies (MIEs) and this makes it difficult to ascertain best practice. The objective of this review was to critically appraise the current evidence addressing the safety, efficacy, and cost-effectiveness of MIEs versus open esophagectomies. A systematic review of the literature was performed by searching nine electronic databases to identify any systematic reviews published on this topic and recommended Joanna Briggs Institute approach to critical appraisal, study selection, data extraction and data synthesis was used to report the findings. A total of 13 systematic reviews of moderate to good quality encompassing 143 primary trials and 36,763 patients were included in the final synthesis. Eleven reviews examined safety parameters and found a generalized benefit of MIE. Efficacy was evaluated by eight systematic reviews and found each method to be equivalent. There were limited data to judiciously appraise cost-effectiveness as this was only evaluated in one review involving a single trial. There is improved safety and equivalent efficacy associated with MIE when compared with open esophagectomy. Cost-effectiveness of MIE cannot be sufficiently supported at this point in time. Further studies, especially those focused on cost-effectiveness are needed to strengthen the existing evidence to inform policy makers on feasibility of increased assimilation of this technology into clinical practice.
传统上，食管肿瘤切除术一直通过开放手术进行，术后病程伴有发病率和死亡率的详细记录。从现代角度来看，微创方法在外科手术的各个领域都获得了持续的支持，随着腹腔镜和机器人技术的出现，这项技术在上消化道手术中得到了迅速应用。目前的文献虽然在不断增加，但在报道微创食管切除术（MIE）的益处方面并不一致，这使得确定最佳实践变得困难。本综述的目的是批判性地评估当前关于MIE与开放食管切除术的安全性、有效性和成本效益的证据。通过搜索九个电子数据库对文献进行系统综述，以识别关于该主题发表的任何系统综述，并采用乔安娜·布里格斯研究所推荐的批判性评估、研究选择、数据提取和数据综合方法来报告研究结果。最终综合纳入了13篇质量中等至良好的系统综述，涵盖143项主要试验和36763名患者。11篇综述研究了安全参数，发现MIE普遍具有优势。八项系统综述评估了有效性，发现两种方法相当。由于仅在一项涉及单个试验的综述中评估了成本效益，因此明智地评估成本效益的数据有限。与开放食管切除术相比，MIE具有更高的安全性和相当的有效性。目前，MIE的成本效益尚无充分依据。需要进一步开展研究，尤其是关注成本效益的研究，以加强现有证据，为政策制定者提供关于将该技术更多地纳入临床实践可行性的信息。
