| 【Background】Esophageal cancer is one of common human maligna ncies, and people almost in all countries around the world suffer esophageal cancer. Despite advances in medical science, esophageal cancer is still the most malignant tumor in the world today, and one of the most common disease of cancer-related death. Esophageal cancer treatment is still a lack of strong evidence-based medicine, and there are many disputes, including the selection of surgical approach, the extent of lymph node cleaning, all kinds of adjuvant treatment efficacy for different patients with esophageal cancer, the efficacy and safety of minimally invasive esophagectomy, and the robot assisted esophagectomy, etc. We searched the related literatures about the comparison studies of esophageal Ivor Lewis operation and Sweet operation as well as the comparison studies of minimally invasive esophagectomy and open thoracic esophagectomy, completed the Meta analysis respectively. We discussed the safety and efficacy of esophageal Ivor Lewis operation and Sweet operation as well as minimally invasive esophagectomy and open thoracic esophagectomy. We would like to provide a good selection of esophagectomies based on the best evidence to thoracic surgeons. 【Aims】1. Investigate the appropriate surgical resection of esophageal cancer by comparing the efficacy and safety between Ivor Lewis esophagectomy and Sweet esophagectomy.2. Investigate the appropriate surgical resection of esophageal cancer by comparing the efficacy and safety between minimal invasive esophagectomy and open thoracic esophagectomy. 【Methods】1. The relevant literatures comparing Ivor Lewis esophagectomy with Sweet esophagectomy were searched through Pub Med, Embase, the Cochrane Library, Google scholar, CNKI, CBM, VIP, Wan Fang Data. Rev Man 5.2 software was used for data analysis.2. The relevant literatures comparing minimal invasive esophagectomy with open thoracic esophagectomy were searched through Pub Med, Embase, the Cochrane Library, CNKI, CBM, VIP, Wan Fang Data. Rev Man 5.3 software was used for data analysis. 【Results】1. A total of 4106 patients in 15 studies were reviewed and the data were pooled for analysis. Meta-analysis showed that, compared with the Sweet group, Ivor Lewis operative time was significantly longer(pooled mean difference = 57.40; 95% CI: 42.43 to 72.38; P = 0.000), operative bleeding was significantly higher(pooled mean difference = 28.39, 95% CI: 4.06 to 52.72, P = 0.02); the number of lymph node dissection significantly more(pooled mean difference = 4.19, 95% CI:3.06 to 5.32, P = 0.000); No significant difference was present in hospital stay, vocal cord paralysis, chylous leakage, pulmonary complications, anastomotic leakage(all P ﹥ 0.05); Ivor Lewis group significantly higher than Sweet group about 3-year survival rate(pooled odds ratio = 1.38, 95% CI:1.06 to 1.80, P = 0.02),but 5- year survival between the two groups showed no significant difference(P = 0.52).2. A total of 3054 patients in 18 studies were reviewed and the data were pooled for analysis. Meta-analysis showed that, compared with the OE group, MIE operative bleeding was significantly lower(pooled mean difference =-131.74,95% CI: 189.70 to-73.79,P = 0.000), the number of lymph node dissection significantly more(pooled mean difference = 1.26, 95% CI:-0.53 to 3.05, P = 0.000), hospital stay was significantly shorter(pooled mean difference =-1.45, 95% CI:-1.86 to-1.05, P = 0.000), pulmonary complications rate was significantly lower(pooled odds radio = 0.46, 95% CI: 0.37 to 0.58, P=0.000), Perioperative mortality rate was significantly lower(pooled odds radio = 0.48,95% CI: 0.28 to 0.84, P=0.01); No significant difference was present in, operative time, cardiac arrhythmias, vocal cord paralysis, chylous leakage, anastomotic leakage(all P﹥0.05). 【Conclusions】1. Ivor Lewis operation can dissect more lymph nodes than Sweet operation, thereby the incidence of tumor recurrence can be reduced, which benefits patients’ future surviving without the increase of complications. Compared with Ivor Lewis operation, Sweet operation is easy operating, time saving, and makes patients have good tolerance.2. Compared with open thoracic esophagectomy, minimal invasive esophagectomy is less bleeding, more lymph nodes removing, less pulmonary complications, shorter hospital stay, lower perioperative mortality. Hence, minimal invasive esophagectomy can achieve the same or even better effect of cancer therapy than open thoracic esophagectomy, moreover, reduce the pain of the patients, which is the better choice of esophageal surgery in the furure.3. Although this topic came to the conclusion of advantages and disadvantages of esophageal Ivor Lewis operation and Sweet operation, of minimal invasive esophagectomy(MIE) and open thorac ic esophagectomy(OE), but still need to carry out large-scale and multi-center randomized controlled trials to obtain more scientific and reliable conclusions. |
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