| Background:Esophageal cancer is one of the most common digestive malignant tumors in the world,with an incidence of 17.87 / 100 000,ranking sixth in all malignant tumors.The morbidity and mortality of esophageal cancer in China are the first in the world,and Henan Province is the most affected area in China.has the highest morbidity and mortality in China.At the present,the treatment for esophageal cancer patients is still conventional surgery,assisted with radiotherapy and chemotherapy.Surgery combined with radiotherapy and chemotherapy is the preferred treatment for cure.In recent years,minimally invasive esophagectomy has been proved to be as safe and effective as open surgery,with decreased complication rates and faster recovery.MIE mainly include two steps: esophagectomy and reconstruction,the most common reconstruction organ is the stomach,and the reconstruction routes include prevertebral route and retrosternal route.Different reconstruction routes lead to different postoperative complications.But so far,there is no consensus on the reconstruction routes in the radical resection of esophageal cancer.Objective:Up to now,there are no large-scale clinical study,and the published reports have different focuses,they can't provide strong evidence in evaluating the actual clinical effects of different reconstruction routes.The aim of this study was to systematically evaluate the efficacy and safety of reconstructions of Retrosternal route and prevertebral route after minimally invasive esophagectomy by Meta-analysis.Methods:According to the Cochran systematic review method and the PRISMA(Preferred Reporting items for systematic reviews and Meta-analyses)report specifications,two researchers searched Pubmed,Embase,Cochrane Controlled Trails Register(CCTR),and China Biology Medicine disc(CBM),CNKI,Wanfang database through independent computers.Chinese search terms include "esophageal cancer","minimally invasive surgery","thoracoscopy","reconstruction path","poststernal path","posterior mediastinum path",etc.English search terms includ “Esophageal Neoplasms”,“Thoracic Surgery”,“Video-Assisted”,“Retrosternal route*”,“prevertebral route*”,“posterior mediastinal route*”,“anterior mediastinal route*”.The retrieval time is from the creation of each database to April 2019,we also traced related references and experts in this field.As well as communicated with other authors to obtain certain informations that had not been found.Randomized and case-control trials compared route of gastric conduit reconstruction after minimally invasive esophagectomy for cancer were included.The statistical software Rev Man 5.3 was used.Results:A total of 15 studies involving 1161 patients were included in this Meta-analysis.Compared to reconstruction of prevertebral route,the incidence of anastomotic leakage of retrosternal reconstruction was higher [OR=2.27,95% CI,(1.50?3.42),P=0.0001];The incidence of pulmonary complications was lower [OR=0.40,95% CI,(0.27,0.58),P<0.00001];There was no statistically significant difference in postoperative cardiovascular complications [OR = 1.04,95% CI,(0.60 ? 1.78),P = 0.89] and anastomotic stenosis [OR = 0.87,95% CI,(0.51,1.49),P = 0.62];shorter postoperative gastrointestinal decompression time [WMD =-0.71,95% CI,(-1.12,-0.31),P = 0.0005];lower incidence of postoperative reflux [OR = 0.31,95% CI,(0.15,0.66),P = 0.002].Conclusion: 1.Compared to reconstruction of prevertebral route with gastric conduit after MIE,the risk of anastomotic leakage through retrosternal route was higher,but the incidence of postoperative pulmonary complications and reflux symptom were lower,long-term quality of life was higher;2.The PR group had lower incidence rate of anastomotic leakage,but postoperative pulmonary complications and reflux incidence were higher;3.There was no significant difference in the incidence of anastomotic stenosis and cardiovascular complications between the two reconstruction rouths. |
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