Short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy and minimally invasive transthoracic esophagectomy for esophageal cancer:A systematic review and meta-analysis
Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy(IVMTE)and minimally invasive transthoracic esophagectomy(MITE)in the treatment of esophageal cancer.Methods The Cochrane Library,EMbase,PubMed,Wanfang Database,VIP,and CNKI were searched.Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4.Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale(NOS)and quality of randomized controlled trial was assessed by Cochrane Handbook.Results A total of 14 studies(12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk)were included,comprising 1 163 patients,with 525 in the IVMTE group and 638 in the MITE group.The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time[MD=-60.42,95％CI(-83.78,-37.07),P＜0.001]and postoperative hospital stay[MD=-2.44,95％CI(-2.93,-1.94),P＜0.01]compared to the MITE group.Moreover,intraoperative blood loss[MD=-34.67,95％CI(-59.11,-10.23),P=0.005],three-day postoperative drainage[MD=-286.66,95％CI(-469.93,-103.40),P=0.002],incidence of postoperative pulmonary infection[OR=0.38,95％CI(0.26,0.56),P＜0.001],lung leakage rate[OR=0.12,95％CI(0.02,0.63),P=0.01]and overall complication rate[MD=0.41,95％CI(0.22,0.75),P=0.004]were all lower in the IVMTE group compared to those in the MITE group.However,the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number[MD=-3.52,95％CI(-6.36,-0.68),P=0.02]and intraoperative recurrent laryngeal nerve injury[OR=1.78,95％CI(1.22,2.60),P=0.003].No significant difference was observed between both methods concerning anastomotic fistula.Conclusion Compared to MITE,IVMTE has advantages such as shorter operation time,less intraoperative blood loss,shorter hospital stay,less postoperative drainage within 3 days,and a lower incidence of pulmonary complications.In terms of laryngeal recurrent nerve injury and lymphatic dissection,MITE operation offers more benefits.
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