A Meta-analysis Of The Efficacy Of Minimally Invasive Surgery And Traditional Open Surgery For Esophageal Cancer

Background:Esophageal cancer is a common type of malignant tumor of upper digestive tract,the incidence of which has escalated year by year.Lack of any obvious symptoms on patients in the early stage of esophageal cancer has made it more difficult to diagnose esophageal cancer in the early stage and most of the patients are diagnosed at the middle and late stage.In spite of the fact that the level of medical treatment is raised gradually,esophageal cancer still has a high mortality.At present,treatments of esophageal cancer include multiple therapies like surgery,endoscopic therapy,chemotherapy,targeted therapy and traditional Chinese medicine,etc.Currently,surgery remains the major approach to a radical cure of esophageal cancer in the middle and late stages.With the gradual maturity of endoscopy,almost all types of surgeries can be done in the form of minimally invasive surgery,and resection of esophageal carcinoma is no exception.For the moment,the safety and effectiveness of minimally invasive esophagectomy(MIE)are still arguable compared with open esophagectomy(OE).Research purposes:This research is aimed to find a better surgery treatment of esophageal cancer between thoracoscopic-lapacoscopic esophagectomy and open esophagectomy.Methods of the research:Relevant literatures were retrieved from the data base of CNKI,VPCS,PUBMED/MEDLINE,OVID,EMBASE,Cochrane Library,CBM Discs by computer,and articles on magazines and conference papers were retrieved manually.All literatures relating to the thoracoscopic-lapacoscopic esophagectomy and open esophagectomy of esophageal cancer were collected,selected and divided into different literatures according to certain criteria,and were scored.Meta-analysis was done by Rev Man5.3 software.Results:2036 literatures were retrieved in the preliminary retrieval,among which 20 Chinese and English papers were selected,with 4 on random control experiments,16 on prospective studies,1 in Chinese and19 in English.There are 1951 group cases of minimally invasive esophagectomy(MIE)and 3869 of open esophagectomy(OE).MIE did reduce blood loss during the surgery(P=0.0009),yet compared with OE,the operation time was longer(P=0.0009).Meanwhile,incidence of respiratory complications was much lower(RR=0.74,95%CI=0.58-0.94,P=0.01)and its general survival rate was higher than that in the OE group(hazard ratio=0.54,95%=0.42-0.70,P<0.00001).These two types of surgery methods were not statistically different in terms of dissected lymph node number,incidence of anastomotic fistula,incidence of anastomotic stenosis,incidence of chylothorax,reoperation,recurrent laryngeal nerve loss,arrhythmia,peri-operative mortality and R0 resection,etc.Conclusion:Compared with open esophagectomy(OE),although minimally invasive esophagectomy(MIE)takes longer time,it has less bleeding during the surgery,with fewer complications,higher overall survival rate and the same,even better,tumor treatment effect.In the meantime,it spares patients the pain of open esophagectomy.Therefore,minimally invasive esophagectomy is a better choice to cure esophageal cancer in the future.