Meta-analysis of randomized controlled trials and individual patient data comparing minimally invasive with open oesophagectomy for cancer
- 1 September 2021
- journal article
- review article
- Published by Oxford University Press (OUP) in British Journal of Surgery
- Vol. 108 (9), 1026-1033
- https://doi.org/10.1093/bjs/znab278
Abstract
Background: Minimally invasive oesophagectomy (MIO) for oesophageal cancer may reduce surgical complications compared with open oesophagectomy. MIO is, however, technically challenging and may impair optimal oncological resection. The aim of the present study was to assess if MIO for cancer is beneficial. Methods: A systematic literature search in MEDLINE, Web of Science and CENTRAL was performed and randomized controlled trials (RCTs) comparing MIO with open oesophagectomy were included in a meta-analysis. Survival was analysed using individual patient data. Random-effects model was used for pooled estimates of perioperative effects. Results: Among 3219 articles, six RCTs were identified including 822 patients. Three-year overall survival (56 (95 per cent c.i. 49 to 62) per cent for MIO versus 52 (95 per cent c.i. 44 to 60) per cent for open; P = 0.54) and disease-free survival (54 (95 per cent c.i. 47 to 61) per cent versus 50 (95 per cent c.i. 42 to 58) per cent; P = 0.38) were comparable. Overall complication rate was lower for MIO (odds ratio 0.33 (95 per cent c.i. 0.20 to 0.53); P < 0.010) mainly due to fewer pulmonary complications (OR 0.44 (95 per cent c.i. 0.27 to 0.72); P < 0.010), including pneumonia (OR 0.41 (95 per cent c.i. 0.22 to 0.77); P < 0.010). Conclusion: MIO for cancer is associated with a lower risk of postoperative complications compared with open resection. Overall and disease-free survival are comparable for the two techniques.This publication has 51 references indexed in Scilit:
- A comparative study of the therapeutic effect in two protocols: video-assisted thoracic surgery combined with laparoscopy versus right open transthoracic esophagectomy for esophageal cancer managementThe Chinese-German Journal of Clinical Oncology, 2013
- The problem of the poor control arm in surgical randomized controlled trialsBritish Journal of Surgery, 2012
- Surgical complications and long-term survival after esophagectomy for cancer in a nationwide Swedish cohort studyEuropean Journal of Surgical Oncology, 2012
- Trends in Hospital Volume and Operative Mortality for High-Risk SurgeryThe New England Journal of Medicine, 2011
- Effect of Immunoglobulin Therapy on the Rate of Infections in Multiple Myeloma Patients Undergoing Autologous Stem Cell Transplantation and or treated with immunomodulatory agentsMediterranean Journal of Hematology and Infectious Diseases, 2010
- Learning curves of minimally invasive esophageal cancer surgery☆European Journal of Cardio-Thoracic Surgery, 2009
- Classification of Surgical ComplicationsAnnals of Surgery, 2004
- Quantifying heterogeneity in a meta-analysisStatistics in Medicine, 2002
- A general parametric approach to the meta‐analysis of randomized clinical trialsStatistics in Medicine, 1991
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986