Comparison Of Short-term Efficacy Between Mediastinoscopic And Thoracoscopic Surgery For Esophageal Cancer:a Meta-analysis

Objective: To systematically evaluate the comparison of short-term efficacy between mediastinoscopic and thoracoscopic surgery for esophageal cancer.Methodes: To search CNKI,VIP Chinese scientific and Technological Journal database,WanFang Data,PubMed,Embase,The Cochrane Library,Web of Science,limited in Chinese or English since the establishment of the databases until February 25,2019.Retrospective methods were used to screen references that were included in the literature.Data analysis was performed using RevMan5.3 software.Results: A total of 338 patients were enrolled in 6 cohort studies,including 132 patients in mediastinoscopic group and 206 patients in thoracoscopic group.There was no significant difference in the proportion of males,age,location of tumors and stage of tumors between mediastinoscopic group and thoracoscopic group(p > 0.05).Meta-analysis showed that the mediastinoscopic group had shorter operation time(WMD=-70.43,95% CI-98.44-42.41,p<0.00001),shorter hospital stay(WMD=-2.30,95% CI-2.98-1.64,p<0.00001),and fewer thoracoabdominal lymph node dissection(WMD=-5.90,95% CI-8.62-3.19,p<0.0001).However,there were no significant differences in bleeding,anastomotic leakage,hoarseness,pulmonary complications,chylous fistula and arrhythmia during operation(p> 0.05).Conclusion: The mediastinoscopic group had shorter operation time,shorter hospitalization time and fewer thoracoabdominal lymph node dissections than the thoracoscopic group,but it did not increase the risk of intraoperative bleeding,anastomotic leakage,hoarseness,pulmonary complications,chylous fistula and arrhythmia.Mediastinoscopy-assisted esophagectomy is still a complementary procedure for patients with thoracoscopic contraindications,such as poor physical condition,severe cardiopulmonary dysfunction,intolerance to one-lung ventilation and severe diffuse pleural adhesions.For patients with esophageal cancer before tumor stage T2,when there is no obvious infiltration of surrounding organs on CT and no obvious enlargement or fusion of lymph nodes in mediastinum,mediastinoscopy-assisted esophagectomy can achieve the therapeutic effect of thoracoscopic-assisted esophageal cancer resection.For patients with stage T3 and T4 esophageal cancer,the indications of mediastinoscopy should be considered.