Eivind Gottlieb-Vedi1, Joonas H Kauppila1,2, George Malietzis3, Magnus Nilsson4, Sheraz R Markar1,3, Jesper Lagergren1,5. 1. Upper Gastrointestinal Surgery, Department of Molecular medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden. 2. Cancer and Translational Medicine Research Unit, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland. 3. Department of Surgery & Cancer, Imperial College London, London, UK. 4. Department of Clinical Science, Intervention and Technology, Karolinska Institutet and Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden. 5. School of Cancer and Pharmaceutical Sciences, King's College London, and Guy's and St Thomas' NHS Foundation Trust, London, UK.
Abstract
OBJECTIVE: Evaluate the existing literature comparing long-term survival after minimally invasive esophagectomy (MIE) and open esophagectomy (OE), and conduct a meta-analysis based on relevant studies. BACKGROUND: It is unknown whether the choice between MIE and OE influences the long-term survival in esophageal cancer. METHODS: A systematic electronic search for articles was performed in Medline, Embase, Web of Science, and Cochrane Library for studies comparing long-term survival after MIE and OE. Additionally, an extensive hand-search was conducted. The I test and χ test were used to test for statistical heterogeneity. Publication bias and small-study effects were assessed using Egger test. A random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year mortality outcomes with adjustment for the covariates age, physical status, tumor stage, and neoadjuvant or adjuvant therapy. The results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: The review identified 55 relevant studies. Among all 14,592 patients, 7358 (50.4%) underwent MIE and 7234 (49.6%) underwent OE. The statistical heterogeneity was limited [I = 12%, 95% confidence interval (CI) 0%-41%, and χ = 0.26] and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Pooled analysis revealed 18% lower 5-year all-cause mortality after MIE compared with OE (HR 0.82, 95% CI 0.76-0.88). The meta-regression indicated no confounding. CONCLUSIONS: The long-term survival after MIE compares well with OE and may even be better. Thus, MIE can be recommended as a standard surgical approach for esophageal cancer.
OBJECTIVE: Evaluate the existing literature comparing long-term survival after minimally invasive esophagectomy (MIE) and open esophagectomy (OE), and conduct a meta-analysis based on relevant studies. BACKGROUND: It is unknown whether the choice between MIE and OE influences the long-term survival in esophageal cancer. METHODS: A systematic electronic search for articles was performed in Medline, Embase, Web of Science, and Cochrane Library for studies comparing long-term survival after MIE and OE. Additionally, an extensive hand-search was conducted. The I test and χ test were used to test for statistical heterogeneity. Publication bias and small-study effects were assessed using Egger test. A random-effects meta-analysis was performed for all-cause 5-year (main outcome) and 3-year mortality, and disease-specific 5-year and 3-year mortality. Meta-regression was performed for the 5-year mortality outcomes with adjustment for the covariates age, physical status, tumor stage, and neoadjuvant or adjuvant therapy. The results were presented as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: The review identified 55 relevant studies. Among all 14,592 patients, 7358 (50.4%) underwent MIE and 7234 (49.6%) underwent OE. The statistical heterogeneity was limited [I = 12%, 95% confidence interval (CI) 0%-41%, and χ = 0.26] and the funnel plot was symmetrical both according to visual and statistical testing (Egger test = 0.32). Pooled analysis revealed 18% lower 5-year all-cause mortality after MIE compared with OE (HR 0.82, 95% CI 0.76-0.88). The meta-regression indicated no confounding. CONCLUSIONS: The long-term survival after MIE compares well with OE and may even be better. Thus, MIE can be recommended as a standard surgical approach for esophageal cancer.
Authors: Masaru Hayami; Nelson Ndegwa; Mats Lindblad; Gustav Linder; Jakob Hedberg; David Edholm; Jan Johansson; Jesper Lagergren; Lars Lundell; Magnus Nilsson; Ioannis Rouvelas Journal: Ann Surg Oncol Date: 2022-06-25 Impact factor: 4.339
Authors: Stepan M Esagian; Ioannis A Ziogas; Konstantinos Skarentzos; Ioannis Katsaros; Georgios Tsoulfas; Daniela Molena; Michalis V Karamouzis; Ioannis Rouvelas; Magnus Nilsson; Dimitrios Schizas Journal: Cancers (Basel) Date: 2022-06-29 Impact factor: 6.575