Skip to main content

Advertisement

SpringerLink
Log in

Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Objectives

At present there is controversy regarding the optimal surgical method for esophageal cancer. Specifically, whether combined thoracoscopic-laparoscopic esophagectomy is superior to open esophagectomy with respect to the surgical wound, perioperative morbidities and mortality, and the overall survival rate is of great concern. This article aimed to compare thoracoscopic-laparoscopic esophagectomy versus open esophagectomy on the perioperative morbidities and long-term survival.

Methods

PubMed, Embase, and Google Scholar databases were searched for relevant studies comparing combined thoracoscopic-laparoscopic esophagectomy with open esophagectomy using the Preferred Reporting Items for Systemic Reviews and Meta-Analyses standards. Odds ratios were extracted to give pooled estimates of the perioperative effect of the two surgical procedures. Hazard ratios were extracted to compare overall survival between the two surgical procedures.

Results

Thirteen studies involving 1549 patients were included in this meta-analysis. We found that patients that underwent combined thoracoscopic-laparoscopic esophagectomy had lower total complication rates (relative risk 1.20; 95 % CI 1.08–1.34; p = 0.0009), wound infection rates, pulmonary complications, and less intraoperative blood loss. Moreover, our study also showed combined thoracoscopic-laparoscopic esophagectomy did not compromise the 5-year survival rate (hazard risk 0.920; 95 % CI 0.720–1.176; p = 0.505) and even improved 2-year survival rate. The 30-day mortality and other common morbidities, including anastomotic leakage, anastomotic stricture, pulmonary infection, chylothorax, arrhythmia, or recurrent laryngeal nerve injury, were not significantly different between combined thoracoscopic-laparoscopic esophagectomy and traditional open esophagectomy (p > 0.05).

Conclusions

Combined thoracoscopic-laparoscopic esophagectomy is a feasible and reliable surgical procedure that can achieve uncompromising long-term survival rates and reduce perioperative complications.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Mao WM, Zheng WH, Ling ZQ (2011) Epidemiologic risk factors for esophageal cancer development. Asian Pac J Cancer Prev 12(10):2461–2466

    PubMed  Google Scholar 

  2. Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90

    Article  PubMed  Google Scholar 

  3. Birkmeyer JD, Siewers AE, Finlayson EV et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346(15):1128–1137

    Article  PubMed  Google Scholar 

  4. D’Amico TA (2011) Improving outcomes after esophagectomy: the importance of preventing postoperative pneumonia. Zhonghua Wei Chang Wai Ke Za Zhi 14(9):660–666

    PubMed  Google Scholar 

  5. Wells GA, Shea B, O’connell D et al (2000) The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 22 Oct 2015

  6. Parmar MKB, Torri V, Stewart L (1998) Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. Stat Med 17(24):2815–2834

    Article  CAS  PubMed  Google Scholar 

  7. Duval S, Tweedie R (2000) Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56(2):455–463

    Article  CAS  PubMed  Google Scholar 

  8. Braghetto I, Csendes A, Cardemil G et al (2006) Open transthoracic or transhiatal esophagectomy versus minimally invasive esophagectomy in terms of morbidity, mortality and survival. Surg Endosc 20(11):1681–1686

    Article  CAS  PubMed  Google Scholar 

  9. Smithers BM, Gotley DC, Martin I et al (2007) Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg 245(2):232–240

    Article  PubMed  PubMed Central  Google Scholar 

  10. Parameswaran R, Veeramootoo D, Krishnadas R et al (2009) Comparative experience of open and minimally invasive esophagogastric resection. World J Surg 33(9):1868–1875

    Article  PubMed  Google Scholar 

  11. Pham TH, Perry KA, Dolan JP et al (2010) Comparison of perioperative outcomes after combined thoracoscopic-laparoscopic esophagectomy and open Ivor–Lewis esophagectomy. Am J Surg 199(5):594–598

    Article  PubMed  Google Scholar 

  12. Safranek PM, Cubitt J, Booth MI et al (2010) Review of open and minimal access approaches to oesophagectomy for cancer. Br J Surg 97(12):1845–1853

    Article  CAS  PubMed  Google Scholar 

  13. Gao Y, Wang Y, Chen L et al (2011) Comparison of open three-field and minimally-invasive esophagectomy for esophageal cancer. Interact Cardiovasc Thorac Surg 12(3):366–369

    Article  PubMed  Google Scholar 

  14. Sundaram A, Geronimo JC, Willer BL et al (2012) Survival and quality of life after minimally invasive esophagectomy: a single-surgeon experience. Surg Endosc 26(1):168–176

    Article  PubMed  Google Scholar 

  15. Biere SSAY, van Berge Henegouwen MI, Maas KW et al (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. The Lancet 379(9829):1887–1892

    Article  Google Scholar 

  16. Kinjo Y, Kurita N, Nakamura F et al (2012) Effectiveness of combined thoracoscopic–laparoscopic esophagectomy: comparison of postoperative complications and midterm oncological outcomes in patients with esophageal cancer. Surg Endosc 26(2):381–390

    Article  PubMed  Google Scholar 

  17. Dolan JP, Kaur T, Diggs BS et al (2013) Impact of comorbidity on outcomes and overall survival after open and minimally invasive esophagectomy for locally advanced esophageal cancer. Surg Endosc 27(11):4094–4103

    Article  PubMed  Google Scholar 

  18. Noble F, Kelly JJ, Bailey IS et al (2013) A prospective comparison of totally minimally invasive versus open Ivor Lewis esophagectomy. Dis Esophagus Off J Int Soc Diseases Esophagus/ISDE 26(3):263

    Article  CAS  Google Scholar 

  19. Li J, Shen Y, Tan L et al (2014) Is minimally invasive esophagectomy beneficial to elderly patients with esophageal cancer? Surg Endosc 29(4):925-930

    Article  CAS  PubMed  Google Scholar 

  20. Kubo N, Ohira M, Yamashita Y et al (2014) The impact of combined thoracoscopic and laparoscopic surgery on pulmonary complications after radical esophagectomy in patients with resectable esophageal cancer. Anticancer Res 34(5):2399–2404

    PubMed  Google Scholar 

  21. Law S, Fok M, Chu KM et al (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122(1):8–14

    Article  CAS  PubMed  Google Scholar 

  22. Nguyen NT, Follette DM, Lemoine PH et al (2001) Minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 72(2):593–596

    Article  CAS  PubMed  Google Scholar 

  23. Wang H, Feng M, Tan L et al (2010) Comparison of the short-term quality of life in patients with esophageal cancer after subtotal esophagectomy via video-assisted thoracoscopic or open surgery. Dis Esophagus 23(5):408–414

    PubMed  Google Scholar 

  24. Luketich JD, Alvelo-Rivera M, Buenaventura PO et al (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238(4):486

    PubMed  PubMed Central  Google Scholar 

  25. Hulscher JBF, van Sandick JW, de Boer AGEM et al (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347(21):1662–1669

    Article  PubMed  Google Scholar 

  26. Biere S, Cuesta MA, Van Der Peet DL (2009) Minimally invasive versus open esophagectomy for cancer: a systematic review and meta-analysis. Miner Chir 64(2):121–133

    CAS  Google Scholar 

  27. Nagpal K, Ahmed K, Vats A et al (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24(7):1621–1629

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We gratefully acknowledge the valuable cooperation of Toni Lerut (Department of Thoracic Surgery, University Hospital Gasthuisberg) and Ting Ye (Department of Thoracic Surgery, Fudan University Shanghai Cancer Center).

Funding

This work was supported by the Grant from the National Natural Science Foundation of China (81272608, 81102044).

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, 200032, China

    Wei Guo, Xiao Ma & Jiaqing Xiang

  2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032, China

    Wei Guo, Xiao Ma, Xiaoli Zhu & Jiaqing Xiang

  3. Department of Thoracic Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, China

    Su Yang & Hecheng Li

  4. Department of Pathology, Fudan University Shanghai Cancer Center (FUSCC), Shanghai, 200032, China

    Xiaoli Zhu

  5. School of Statistic, Renmin University of China, Beijing, 100086, China

    Wei Qin

  6. Department of Thoracic Surgery, University Hospital Gasthuisberg, Herestraat 49, 3000, Louvain, Belgium

    Toni Lerut

Authors
  1. Wei Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiao Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Su Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Xiaoli Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Wei Qin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jiaqing Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toni Lerut
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hecheng Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hecheng Li.

Ethics declarations

Disclosures

Wei Guo, Xiao Ma, Su Yang, Xiaoli Zhu, Wei Qin, Jiaqing Xiang, Toni Lerut, and Hecheng Li have no conflicts of interest or financial ties to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, W., Ma, X., Yang, S. et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc 30, 3873–3881 (2016). https://doi.org/10.1007/s00464-015-4692-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-015-4692-x

Keywords

Search

Navigation