Minimally invasive esophagectomy versus open esophagectomy for esophageal cancer: a meta-analysis

The safety and effectiveness of minimally invasive esophagectomy (MIE) in comparison with the open esophagectomy (OE) remain uncertain in esophageal cancer treatment. The purpose of this meta-analysis is to compare the outcomes of the two surgical modalities. Searches were conducted in MEDLINE, EMBASE, and ClinicalTrials.gov with the following index words: "esophageal cancer", "VATS", "MIE", "thoracoscopic esophagectomy", and "open esophagectomy" for relative studies that compared the effects between MIE and OE. Random-effect models were used, and heterogeneity was assessed. A total of 20 studies were included in the analysis, consisting of four randomized controlled trials and 16 prospective studies. MIE has reduced operative blood loss ( =0.0009) but increased operation time ( =0.009) in comparison with OE. Patients get less respiratory complications (risk ratio =0.74, 95% CI =0.58-0.94, =0.01) and better overall survival (hazard ratio =0.54, 95% CI =0.42-0.70,