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Meta-analysis of randomized controlled trials and individual patient data comparing minimally invasive with open oesophagectomy for cancer

B P Müller-Stich, P Probst, H Nienhüser, S Fazeli, J Senft, E Kalkum, P Heger, Rene Warschkow, F Nickel, A T Billeter, P P Grimminger, C Gutschow, T S Dabakuyo-Yonli, G Piessen, M Paireder, S F Schoppmann, D L Van Der Peet, M A Cuesta, P Van Der Sluis, R Van Hillegersberg, A H Hölscher, M K Diener & T Schmidt

abstract

BACKGROUND
Minimally invasive oesophagectomy (MIO) for oesophageal cancer may reduce surgical complications compared with open oesophagectomy. MIO is, however, technically challenging and may impair optimal oncological resection. The aim of the present study was to assess if MIO for cancer is beneficial.

METHODS
A systematic literature search in MEDLINE, Web of Science and CENTRAL was performed and randomized controlled trials (RCTs) comparing MIO with open oesophagectomy were included in a meta-analysis. Survival was analysed using individual patient data. Random-effects model was used for pooled estimates of perioperative effects.

RESULTS
Among 3219 articles, six RCTs were identified including 822 patients. Three-year overall survival (56 (95 per cent c.i. 49 to 62) per cent for MIO versus 52 (95 per cent c.i. 44 to 60) per cent for open; P = 0.54) and disease-free survival (54 (95 per cent c.i. 47 to 61) per cent versus 50 (95 per cent c.i. 42 to 58) per cent; P = 0.38) were comparable. Overall complication rate was lower for MIO (odds ratio 0.33 (95 per cent c.i. 0.20 to 0.53); P < 0.010) mainly due to fewer pulmonary complications (OR 0.44 (95 per cent c.i. 0.27 to 0.72); P < 0.010), including pneumonia (OR 0.41 (95 per cent c.i. 0.22 to 0.77); P < 0.010).

CONCLUSION
MIO for cancer is associated with a lower risk of postoperative complications compared with open resection. Overall and disease-free survival are comparable for the two techniques.

LAY SUMMARY
Oesophagectomy for cancer is associated with a high risk of complications. A minimally invasive approach might be less traumatic, leading to fewer complications and may also improve oncological outcome. A meta-analysis of randomized controlled trials comparing minimally invasive to open oesophagectomy was performed. The analysis showed that the minimally invasive approach led to fewer postoperative complications, in particular, fewer pulmonary complications. Survival after surgery was comparable for the two techniques.
   
citation Müller-Stich B P, Probst P, Nienhüser H, Fazeli S, Senft J, Kalkum E, Heger P, Warschkow R, Nickel F, Billeter A T, Grimminger P P, Gutschow C, Dabakuyo-Yonli T S, Piessen G, Paireder M, Schoppmann S F, van der Peet D L, Cuesta M A, van der Sluis P, van Hillegersberg R, Hölscher A H, Diener M K, Schmidt T. Meta-analysis of randomized controlled trials and individual patient data comparing minimally invasive with open oesophagectomy for cancer. Br J Surg 2021; 108:1026-1033.
   
type journal paper/review (English)
date of publishing 27-9-2021
journal title Br J Surg (108/9)
ISSN electronic 1365-2168
pages 1026-1033
PubMed 34491293
DOI 10.1093/bjs/znab278