Short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy and minimally invasive transthoracic esophagectomy for esophageal cancer: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Keyong ¹ , CHENG Tao ¹ , JIN Dacheng ² , YE Zhibo ¹ , QUE Changhao ¹ , WANG Yaping ¹ ,  BAI Qizhou ^1,2

1. The First Clinical Department of Gansu University of Traditional Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Department of Thoracic Surgery, Gansu Provincial Hospital, Lanzhou, 730000, P. R. China;

Corresponding?author：

BAI Qizhou, Email: baiqizhou@163.com

Keywords：

Inflatable mediastinoscopy; minimally invasive esophagectomy; esophageal neoplasms; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202312050

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive transthoracic esophagectomy (MITE) in the treatment of esophageal cancer. Methods The Cochrane Library, EMbase, PubMed, Wanfang Database, VIP, and CNKI were searched. Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4. Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale (NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook. Results A total of 14 studies (12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included, comprising 1 163 patients, with 525 in the IVMTE group and 638 in the MITE group. The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time [MD=?60.42, 95%CI (?83.78, ?37.07), P<0.001] and postoperative hospital stay [MD=?2.44, 95%CI (?2.93, ?1.94), P<0.01] compared to the MITE group. Moreover, intraoperative blood loss [MD=?34.67, 95%CI (?59.11, ?10.23), P=0.005], three-day postoperative drainage [MD=?286.66, 95%CI (?469.93, ?103.40), P=0.002], incidence of postoperative pulmonary infection [OR=0.38, 95%CI (0.26, 0.56), P<0.001], lung leakage rate [OR=0.12, 95% CI (0.02, 0.63), P=0.01] and overall complication rate [MD=0.41, 95%CI (0.22, 0.75), P=0.004] were all lower in the IVMTE group compared to those in the MITE group. However, the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=?3.52, 95%CI (?6.36, –0.68), P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78, 95%CI (1.22, 2.60), P=0.003]. No significant difference was observed between both methods concerning anastomotic fistula. Conclusion Compared to MITE, IVMTE has advantages such as shorter operation time, less intraoperative blood loss, shorter hospital stay, less postoperative drainage within 3 days, and a lower incidence of pulmonary complications. In terms of laryngeal recurrent nerve injury and lymphatic dissection, MITE operation offers more benefits.

Citation： LI Keyong, CHENG Tao, JIN Dacheng, YE Zhibo, QUE Changhao, WANG Yaping, BAI Qizhou. Short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy and minimally invasive transthoracic esophagectomy for esophageal cancer: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(7): 1027-1034. doi: 10.7507/1007-4848.202312050 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 ccountries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Ma L, Li X, Wang M, et al. The incidence,mortality, and DALYs trends associated with esophageal cancer—China, 1990-2019. China CDC Wkly, 2022, 4(43): 956-961.
3.	劉宇英, 魏君麗, 江柔, 等. 食管癌的流行病學及篩查研究進展. 中華疾病控制雜志, 2022, 26(7): 839-844.
4.	Xie J, Zhang L, Liu Z, et al. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: Propensity score matching analysis of 169 cases. World J Surg Oncol, 2022, 20(1): 52.
5.	劉慶文, 武強, 唐桂旺, 等. 縱隔鏡在食管癌根治術中的研究進展. 中國胸心血管外科臨床雜志, 2019, 26(7): 728-733.
6.	Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg, 2012, 16(3): 486-494.
7.	Espinoza-Mercado F, Imai TA, Borgella JD, et al. Does the approach matter? Comparing survival in robotic, minimally invasive, and open esophagectomies. Ann Thorac Surg, 2019, 107(2): 378-385.
8.	Ising MS, Smith SA, Trivedi JR, et al. Minimally invasive esophagectomy is associated with superior survival compared to open surgery. Am Surg, 2023, 89(5): 1833-1843.
9.	Song S, Shen C, Hu Y, et al. Application of inflatable video-assisted mediastinoscopic transhiatal esophagectomy in individualized treatment of esophageal cancer. Biomedicines, 2023, 11(10): 2750.
10.	Weksler B, Sullivan JL. Survival after esophagectomy: A propensity-matched study of different surgical approaches. Ann Thorac Surg, 2017, 104(4): 1138-1146.
11.	陳椿, 施瑞卿. 微創食管癌切除術與開放食管癌切除術的多中心隨機對照研究. 循證醫學, 2015, 15(5): 266-267.
12.	王文憑, 何松林, 楊玉賞, 等. 食管癌微創外科手術的現狀與思考. 中國胸心血管外科臨床雜志, 2018, 25(4): 338-344.
13.	Yin Q, Liu H, Song Y, et al. Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma. J Cardiothorac Surg, 2020, 15(1): 125.
14.	黃志寧, 柳常青, 郭明發, 等. 充氣式縱隔鏡聯合腹腔鏡食管癌切除術的臨床分析. 中華外科雜志, 2023, 61(1): 48-53.
15.	柳常青, 吳漢然, 郭明發, 等. 改良充氣式縱隔鏡在早期胸段食管癌中的臨床應用. 中華胸心血管外科雜志, 2019, 35(2): 80-85.
16.	Wang G, Sun X, Li T, et al. Study of the short-term quality of life of patients with esophageal cancer after inflatable videoassisted mediastinoscopic transhiatal esophagectomy. Front Surg, 2023, 9: 981576.
17.	Shi K, Qian R, Zhang X, et al. Video-assisted mediastinoscopic and laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc, 2022, 36(6): 4207-4214.
18.	Sasaki K, Tsuruda Y, Shimonosono M, et al. A comparison of the surgical invasiveness and short-term outcomes between thoracoscopic and pneumatic mediastinoscopic esophagectomy for esophageal cancer. Surg Today, 2022, 52(12): 1759-1765.
19.	Guo L, Zhao Q, Wang K, et al. A case-control study on the therapeutic effect of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Surg Innov, 2021, 28(3): 316-322.
20.	Liu W, Guo X, Zhao H, et al. Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: A single-center initial experience. J Thorac Dis, 2020, 12(9): 4908-4914.
21.	Jin Y, Lu X, Xue L, et al. Retrospective comparison of two minimally invasive esophagectomy in the treatment of esophageal cancer: Pneumatic mediastinoscopy versus thoracoscopy. J Laparoendosc Adv Surg Tech A, 2019, 29(5): 638-642.
22.	Chen Z, Huang K, Wei R, et al. Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: A propensity score-matched analysis. J Surg Oncol, 2022, 125(5): 839-846.
23.	孫曉冬. 單孔充氣式縱隔鏡聯合腹腔鏡與腔鏡Mckeown在食管癌治療中的對比研究. 皖南醫學院, 2022.
24.	張廣敬, 姜美玲, 張康, 等. 充氣式縱隔腔鏡與微創McKeown手術治療食管癌的效果評價. 實用臨床醫藥雜志, 2018, 22(19): 25-28.
25.	楊俊. 改良充氣式縱隔鏡在早期胸段食管癌中的臨床應用. 當代醫學, 2021, 27(29): 172-173.
26.	王嘉瑋. 單孔充氣式縱隔鏡聯合腹腔鏡食管癌根治術治療食管癌的效果分析. 當代醫藥論叢, 2020, 18(23): 25-26.
27.	羅德惠, 萬翔, 劉際明, 等. 如何實現從樣本量、中位數、極值或四分位數到均數與標準差的轉換. 中國循證醫學雜志, 2017, 17(11): 1350-1356.
28.	王謙, 劉慧兵, 張魯昌, 等. 單孔充氣式縱隔鏡輔助經裂孔食管切除術與功能性食管癌切除術的比較: 單中心傾向性評分匹配研究. 中國胸心血管外科臨床雜志, 2023. Epub ahead of print.
29.	Gupta B, Kumar N. Worldwide incidence, mortality and time trends for cancer of the oesophagus. Eur J Cancer Prev, 2017, 26(2): 107-118.
30.	Kalff MC, Vesseur I, Eshuis WJ, et al. The association of textbook outcome and long-term survival after esophagectomy for esophageal cancer. Ann Thorac Surg, 2021, 112(4): 1134-1141.
31.	Lee YK, Chen KC, Huang PM, et al. Selection of minimally invasive surgical approaches for treating esophageal cancer. Thorac Cancer, 2022, 13(15): 2100-2105.
32.	Akhtar NM, Chen D, Zhao Y, et al. Postoperative short-term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta-analysis. Thorac Cancer, 2020, 11(6): 1465-1475.
33.	Chen L, Liu X, Wang R, et al. Minimally invasive esophagectomy for esophageal cancer according to the location of the tumor: Experience of 251 patients. Ann Med Surg (Lond), 2017, 17: 54-60.
34.	Li Z, Liu C, Liu Y, et al. Comparisons between minimally invasive and open esophagectomy for esophageal cancer with cervical anastomosis: A retrospective study. J Cardiothorac Surg, 2020, 15(1): 128.
35.	van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor-Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
36.	Buess G, Becker HD. Minimally invasive surgery in tumors of the esophagus. Langenbecks Archiv Fur Chirurgie Supplement Ⅱ, Verhandlungen der Deutschen Gesellschaft fur Chirurgie Deutsche Gesellschaft fur Chirurgie Kongress, 1990: 1355-1360.
37.	Fujiwara H, Shiozaki A, Konishi H, et al. Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve. Ann Thorac Surg, 2015, 100(3): 1115-1117.
38.	Li GS, Cao QD. Single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer. J Thorac Dis, 2016, 8(9): E1108-E1109.
39.	Yibulayin X, Xu K, Yibulayin W, et al. Single-port inflatable mediastinoscopic esophagectomy is a cure for esophageal cancer patients: Case report. Medicine (Baltimore), 2022, 101(46): e31619.
40.	Daiko H, Oguma J, Fujiwara H, et al. Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy: A truly minimally invasive procedure. Surg Endosc, 2021, 35(9): 5186-5192.
41.	方云昊, 陳子豪, 韋榮強, 等. 充氣縱隔鏡與電視胸腔鏡聯合腹腔鏡手術治療食管癌的短期隨訪結果比較. 中國胸心血管外科臨床雜志, 2021, 28(2): 239-242.
42.	Tandon S, Batchelor A, Bullock R, et al. Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth, 2001, 86(5): 633-638.
43.	Hu W, Yuan P, Yuan Y, et al. Learning curve for inflatable mediastinoscopic and laparoscopic-assisted esophagectomy. Surg Endosc, 2023, 37(6): 4486-4494.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 ccountries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Ma L, Li X, Wang M, et al. The incidence,mortality, and DALYs trends associated with esophageal cancer—China, 1990-2019. China CDC Wkly, 2022, 4(43): 956-961.
3. 劉宇英, 魏君麗, 江柔, 等. 食管癌的流行病學及篩查研究進展. 中華疾病控制雜志, 2022, 26(7): 839-844.
4. Xie J, Zhang L, Liu Z, et al. Advantages of McKeown minimally invasive oesophagectomy for the treatment of oesophageal cancer: Propensity score matching analysis of 169 cases. World J Surg Oncol, 2022, 20(1): 52.
5. 劉慶文, 武強, 唐桂旺, 等. 縱隔鏡在食管癌根治術中的研究進展. 中國胸心血管外科臨床雜志, 2019, 26(7): 728-733.
6. Dantoc MM, Cox MR, Eslick GD. Does minimally invasive esophagectomy (MIE) provide for comparable oncologic outcomes to open techniques? A systematic review. J Gastrointest Surg, 2012, 16(3): 486-494.
7. Espinoza-Mercado F, Imai TA, Borgella JD, et al. Does the approach matter? Comparing survival in robotic, minimally invasive, and open esophagectomies. Ann Thorac Surg, 2019, 107(2): 378-385.
8. Ising MS, Smith SA, Trivedi JR, et al. Minimally invasive esophagectomy is associated with superior survival compared to open surgery. Am Surg, 2023, 89(5): 1833-1843.
9. Song S, Shen C, Hu Y, et al. Application of inflatable video-assisted mediastinoscopic transhiatal esophagectomy in individualized treatment of esophageal cancer. Biomedicines, 2023, 11(10): 2750.
10. Weksler B, Sullivan JL. Survival after esophagectomy: A propensity-matched study of different surgical approaches. Ann Thorac Surg, 2017, 104(4): 1138-1146.
11. 陳椿, 施瑞卿. 微創食管癌切除術與開放食管癌切除術的多中心隨機對照研究. 循證醫學, 2015, 15(5): 266-267.
12. 王文憑, 何松林, 楊玉賞, 等. 食管癌微創外科手術的現狀與思考. 中國胸心血管外科臨床雜志, 2018, 25(4): 338-344.
13. Yin Q, Liu H, Song Y, et al. Clinical application and observation of single-port inflatable mediastinoscopy combined with laparoscopy for radical esophagectomy in esophageal squamous cell carcinoma. J Cardiothorac Surg, 2020, 15(1): 125.
14. 黃志寧, 柳常青, 郭明發, 等. 充氣式縱隔鏡聯合腹腔鏡食管癌切除術的臨床分析. 中華外科雜志, 2023, 61(1): 48-53.
15. 柳常青, 吳漢然, 郭明發, 等. 改良充氣式縱隔鏡在早期胸段食管癌中的臨床應用. 中華胸心血管外科雜志, 2019, 35(2): 80-85.
16. Wang G, Sun X, Li T, et al. Study of the short-term quality of life of patients with esophageal cancer after inflatable videoassisted mediastinoscopic transhiatal esophagectomy. Front Surg, 2023, 9: 981576.
17. Shi K, Qian R, Zhang X, et al. Video-assisted mediastinoscopic and laparoscopic transhiatal esophagectomy for esophageal cancer. Surg Endosc, 2022, 36(6): 4207-4214.
18. Sasaki K, Tsuruda Y, Shimonosono M, et al. A comparison of the surgical invasiveness and short-term outcomes between thoracoscopic and pneumatic mediastinoscopic esophagectomy for esophageal cancer. Surg Today, 2022, 52(12): 1759-1765.
19. Guo L, Zhao Q, Wang K, et al. A case-control study on the therapeutic effect of mediastinoscope-assisted and thoracoscope-assisted esophagectomy. Surg Innov, 2021, 28(3): 316-322.
20. Liu W, Guo X, Zhao H, et al. Mediastinoscopy-assisted transhiatal esophagectomy versus thoraco-laparoscopic esophagectomy for esophageal cancer: A single-center initial experience. J Thorac Dis, 2020, 12(9): 4908-4914.
21. Jin Y, Lu X, Xue L, et al. Retrospective comparison of two minimally invasive esophagectomy in the treatment of esophageal cancer: Pneumatic mediastinoscopy versus thoracoscopy. J Laparoendosc Adv Surg Tech A, 2019, 29(5): 638-642.
22. Chen Z, Huang K, Wei R, et al. Transcervical inflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: A propensity score-matched analysis. J Surg Oncol, 2022, 125(5): 839-846.
23. 孫曉冬. 單孔充氣式縱隔鏡聯合腹腔鏡與腔鏡Mckeown在食管癌治療中的對比研究. 皖南醫學院, 2022.
24. 張廣敬, 姜美玲, 張康, 等. 充氣式縱隔腔鏡與微創McKeown手術治療食管癌的效果評價. 實用臨床醫藥雜志, 2018, 22(19): 25-28.
25. 楊俊. 改良充氣式縱隔鏡在早期胸段食管癌中的臨床應用. 當代醫學, 2021, 27(29): 172-173.
26. 王嘉瑋. 單孔充氣式縱隔鏡聯合腹腔鏡食管癌根治術治療食管癌的效果分析. 當代醫藥論叢, 2020, 18(23): 25-26.
27. 羅德惠, 萬翔, 劉際明, 等. 如何實現從樣本量、中位數、極值或四分位數到均數與標準差的轉換. 中國循證醫學雜志, 2017, 17(11): 1350-1356.
28. 王謙, 劉慧兵, 張魯昌, 等. 單孔充氣式縱隔鏡輔助經裂孔食管切除術與功能性食管癌切除術的比較: 單中心傾向性評分匹配研究. 中國胸心血管外科臨床雜志, 2023. Epub ahead of print.
29. Gupta B, Kumar N. Worldwide incidence, mortality and time trends for cancer of the oesophagus. Eur J Cancer Prev, 2017, 26(2): 107-118.
30. Kalff MC, Vesseur I, Eshuis WJ, et al. The association of textbook outcome and long-term survival after esophagectomy for esophageal cancer. Ann Thorac Surg, 2021, 112(4): 1134-1141.
31. Lee YK, Chen KC, Huang PM, et al. Selection of minimally invasive surgical approaches for treating esophageal cancer. Thorac Cancer, 2022, 13(15): 2100-2105.
32. Akhtar NM, Chen D, Zhao Y, et al. Postoperative short-term outcomes of minimally invasive versus open esophagectomy for patients with esophageal cancer: An updated systematic review and meta-analysis. Thorac Cancer, 2020, 11(6): 1465-1475.
33. Chen L, Liu X, Wang R, et al. Minimally invasive esophagectomy for esophageal cancer according to the location of the tumor: Experience of 251 patients. Ann Med Surg (Lond), 2017, 17: 54-60.
34. Li Z, Liu C, Liu Y, et al. Comparisons between minimally invasive and open esophagectomy for esophageal cancer with cervical anastomosis: A retrospective study. J Cardiothorac Surg, 2020, 15(1): 128.
35. van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor-Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
36. Buess G, Becker HD. Minimally invasive surgery in tumors of the esophagus. Langenbecks Archiv Fur Chirurgie Supplement Ⅱ, Verhandlungen der Deutschen Gesellschaft fur Chirurgie Deutsche Gesellschaft fur Chirurgie Kongress, 1990: 1355-1360.
37. Fujiwara H, Shiozaki A, Konishi H, et al. Single-port mediastinoscopic lymphadenectomy along the left recurrent laryngeal nerve. Ann Thorac Surg, 2015, 100(3): 1115-1117.
38. Li GS, Cao QD. Single-port inflatable mediastinoscopy combined with laparoscopy for the radical treatment of esophageal cancer. J Thorac Dis, 2016, 8(9): E1108-E1109.
39. Yibulayin X, Xu K, Yibulayin W, et al. Single-port inflatable mediastinoscopic esophagectomy is a cure for esophageal cancer patients: Case report. Medicine (Baltimore), 2022, 101(46): e31619.
40. Daiko H, Oguma J, Fujiwara H, et al. Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy: A truly minimally invasive procedure. Surg Endosc, 2021, 35(9): 5186-5192.
41. 方云昊, 陳子豪, 韋榮強, 等. 充氣縱隔鏡與電視胸腔鏡聯合腹腔鏡手術治療食管癌的短期隨訪結果比較. 中國胸心血管外科臨床雜志, 2021, 28(2): 239-242.
42. Tandon S, Batchelor A, Bullock R, et al. Peri-operative risk factors for acute lung injury after elective oesophagectomy. Br J Anaesth, 2001, 86(5): 633-638.
43. Hu W, Yuan P, Yuan Y, et al. Learning curve for inflatable mediastinoscopic and laparoscopic-assisted esophagectomy. Surg Endosc, 2023, 37(6): 4486-4494.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy and minimally invasive transthoracic esophagectomy for esophageal cancer: A systematic review and meta-analysis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content