Background: Open transthoracic oesophogectomy is a major procedure which is associated with significant morbidity and mortality. Recently thoracoscopic procedures have offered a potentially advantageous alternative because of less operative trauma compared with thoracotomy. The aim of this study was to compare outcomes of open oesophagectomy(OE) with the best available minimally invasive technique, total minimally invasive oesophagectomy (TMIE).
Methods: Literature search was performed using Embase, Medline, Cochrane Library, and Google Scholar databases for comparative studies assessing different techniques of oesophagectomy. Only studies on humans and in English language were considered for inclusion. A random effects model was used for meta-analysis and heterogeneity was assessed. Primary outcome of interest were 30-day mortality and anastomotic leak. Secondary outcomes included technique-related complications, postoperative morbidity and oncological clearance in terms of lymph node retrieved.
Results: Out of 281 studies identified, a total of six studies were included in the analysis finally. Studies included a total of 206 patients for TMIE and 333 for open oesophagectomy. There was no significant difference in the 30-day mortality and anastomotic leak between the two groups (OR 0.45; p = 0.10, OR 0.53, p= 0.05). Total morbidity was significantly lower in TMIE group (p= 0.02, OR=0.47, 95% CI 0.25, 0.87). Sub-analysis of co-morbidities revealed no significant difference in cardio-respiratory complications between the two groups. For all other operative and post-operative outcomes, there was no significant difference between the two groups. In addition, there was no significant difference in terms of lymph nodes retrieved between the two groups.
Conclusions: This meta-analysis demonstrated that TMIE decreased total morbidity compared to conventional oesophagectomy. However, 30-day mortality and morbidity in terms of cardio respiratory complications did not improve. Although the results suggest some advantages from the minimal invasive approach, large multi-institution trials are necessary before any claims can be made for the superiority of the minimally invasive approach in normal surgical practice.
Program Number: P363