Institute of Translational Medicine, University of Pécs, Medical School, Pécs 7624, Hungary.
János Szentágothai Research Centre, University of Pécs, Medical School, Pécs 7624, Hungary.
World J Gastroenterol. 2022 Aug 14;28(30):4201-4210. doi: 10.3748/wjg.v28.i30.4201.
Previous meta-analyses, with many limitations, have described the beneficial nature of minimal invasive procedures.
To compare all modalities of esophagectomies to each other from the results of randomized controlled trials (RCTs) in a network meta-analysis (NMA).
We conducted a systematic search of the MEDLINE, EMBASE, (https://www.referencecitationanalysis.com/) and CENTRAL databases to identify RCTs according to the following population, intervention, control, outcome (commonly known as PICO): P: Patients with resectable esophageal cancer; I/C: Transthoracic, transhiatal, minimally invasive (thoracolaparoscopic), hybrid, and robot-assisted esophagectomy; O: Survival, total adverse events, adverse events in subgroups, length of hospital stay, and blood loss. We used the Bayesian approach and the random effects model. We presented the geometry of the network, results with probabilistic statements, estimated intervention effects and their 95% confidence interval (CI), and the surface under the cumulative ranking curve to rank the interventions.
We included 11 studies in our analysis. We found a significant difference in postoperative pulmonary infection, which favored the minimally invasive intervention compared to transthoracic surgery (risk ratio 0.49; 95%CI: 0.23 to 0.99). The operation time was significantly shorter for the transhiatal approach compared to transthoracic surgery (mean difference -85 min; 95%CI: -150 to -29), hybrid intervention (mean difference -98 min; 95%CI: -190 to -9.4), minimally invasive technique (mean difference -130 min; 95%CI: -210 to -50), and robot-assisted esophagectomy (mean difference -150 min; 95%CI: -240 to -53). Other comparisons did not yield significant differences.
Based on our results, the implication of minimally invasive esophagectomy should be favored.
之前的荟萃分析存在诸多局限性，仅描述了微创术式的有益性。
通过网络荟萃分析（NMA），比较食管切除术各种术式之间的结果。
我们系统检索了 MEDLINE、EMBASE、（https://www.referencecitationanalysis.com/）和 CENTRAL 数据库，根据以下人群、干预、对照、结局（通常称为 PICO），确定 RCT：P：可切除的食管癌患者；I/C：经胸、经胸食管裂孔、微创（胸腹腔镜联合）、杂交、机器人辅助食管切除术；O：生存、总不良事件、亚组不良事件、住院时间和出血量。我们采用贝叶斯方法和随机效应模型。我们展示了网络的结构、概率性结果、估计的干预效果及其 95%置信区间（CI），以及累积排序曲线下的面积，以对干预措施进行排序。
我们的分析纳入了 11 项研究。我们发现术后肺部感染有显著差异，微创干预优于经胸手术（风险比 0.49；95%CI：0.23 至 0.99）。与经胸手术相比，经食管裂孔入路的手术时间显著缩短（平均差 -85 分钟；95%CI：-150 至-29）、杂交干预（平均差-98 分钟；95%CI：-190 至-9.4）、微创技术（平均差-130 分钟；95%CI：-210 至-50）和机器人辅助食管切除术（平均差-150 分钟；95%CI：-240 至-53）。其他比较没有产生显著差异。
根据我们的结果，微创食管切除术的应用应该受到青睐。
