Totally minimally invasive esophagectomy versus hybrid minimally invasive esophagectomy: systematic review and meta-analysis

Abstract

Summary Minimally invasive esophagectomy is increasingly performed for the treatment of esophageal cancer, but it is unclear whether hybrid minimally invasive esophagectomy (HMIE) or totally minimally invasive esophagectomy (TMIE) should be preferred. The objective of this study was to perform a meta-analysis of studies comparing HMIE with TMIE. A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Articles comparing HMIE and TMIE were included. The Newcastle–Ottawa scale was used for critical appraisal of methodological quality. The primary outcome was pneumonia. Sensitivity analysis was performed by analyzing outcome for open chest hybrid MIE versus total TMIE and open abdomen MIE versus TMIE separately. Therefore, subgroup analysis was performed for laparoscopy-assisted HMIE versus TMIE, thoracoscopy-assisted HMIE versus TMIE, Ivor Lewis HMIE versus Ivor Lewis TMIE, and McKeown HMIE versus McKeown TMIE. There were no randomized controlled trials. Twenty-nine studies with a total of 3732 patients were included. Studies had a low to moderate risk of bias. In the main analysis, the pooled incidence of pneumonia was 19.0% after HMIE and 9.8% after TMIE which was not significantly different between the groups (RR: 1.46, 95% CI: 0.97–2.20). TMIE was associated with a lower incidence of wound infections (RR: 1.81, 95% CI: 1.13–2.90) and less blood loss (SMD: 0.78, 95% CI: 0.34–1.22) but with longer operative time (SMD:-0.33, 95% CI: −0.59—-0.08). In subgroup analysis, laparoscopy-assisted HMIE was associated with a higher lymph node count than TMIE, and Ivor Lewis HMIE was associated with a lower anastomotic leakage rate than Ivor Lewis TMIE. In general, TMIE was associated with moderately lower morbidity compared to HMIE, but randomized controlled evidence is lacking. The higher leakage rate and lower lymph node count that was found after TMIE in sensitivity analysis indicate that TMIE can also have disadvantages. The findings of this meta-analysis should be considered carefully by surgeons when moving from HMIE to TMIE.

Surgery by a minimally invasive approach is associated with improved textbook outcomes in oesophageal and gastric cancer

“…There is also increasing interest in the usage of robotic assisted platforms for oesophagectomy [19]. Both hybrid and totally MIA oesophagectomy show improved peri-operative outcomes and at least equivalent survival outcomes when compared with open procedures [13,14,16].…”

Outcomes after totally minimally invasive versus hybrid and open Ivor Lewis oesophagectomy: results from the International Esodata Study Group.

“…In the present study, a higher anastomotic leakage rate was reported for TMIE than hybrid oesophagectomy. The meta-analysis 27 that compared TMIE with hybrid oesophagectomy reported a significant increase in anastomotic leakage rate for TMIE compared with hybrid Ivor Lewis oesophagectomy. This was most probably due to the technically challenging minimally invasive intrathoracic anastomosis.…”

Open versus hybrid versus totally minimally invasive Ivor Lewis esophagectomy: Systematic review and meta-analysis

“…[9][10][11][12][13][14] However, because a totally minimally invasive transthoracic esophagectomy is a challenging and demanding procedure, some esophageal surgeons still perform open (OE) or hybrid esophagectomy (HE). [15][16][17][18][19][20] The aim of this systematic review and meta-analysis was to compare surgical outcomes between OE, HE, and totally minimally invasive Ivor Lewis esophagectomy (TMIE).…”