Combined Minimally Invasive Esophagectomy Versus Open Esophagectomy: A Meta-analysis Of Complications

Objective: Some investigations have found that the incidence of esophageal cancer accounts for the sixth highest incidence of all malignant tumors,and the mortality rate is the fourth among all malignant tumor mortality in China.The high mortality rate is closely related the current surgical trauma of esophageal cancer and postoperative complications.There is still no clear consensus on the choice of traditional thoracotomy and minimally invasive surgery.This study used systematic evaluation of minimally invasive esophagectomy(MIE)and open esophagectomy(OE)treatment of esophageal cancer,compared with the differences in postoperative complications,to provide a reference for the choice of radical esophageal cancer surgery.Methods : Search for minimally invasive esophagectomy by searching Chinese Journal Full-text Database,Wanfang Database,China Biomedical Literature Database,VIP Database,PubMed,The Cochrane Library,Web of Science,Springer Clinical comparative study of routine open esophageal cancer radical surgery for postoperative complications of esophageal cancer.Meta-analysis was performed using Review Manager 5.3 software to evaluate relevant indicators such as anastomotic leakage,pulmonary infection,chylothorax,wound infection,arrhythmia,and recurrent laryngeal nerve injury,pulmonary embolism and total complications.Results: In the end,there were 26 relevant research literatures,including 14 Chinese literatures and 12 English literatures.There were 3,750 patients,including 1873 patients with minimally invasive esophagectomy undergoing and open esophagectomy has 1877 patients.Meta-analysis results show that minimally invasive surgery for esophageal cancer can reduce postoperative arrhythmia(OR=0.65,95% CI [0.49,0.87],P<0.05),pulmonary infection,compared with traditional open esophagectomy(OR=0.54,95% CI [0.44,0.67],P<0.05),incision infection(OR=0.32,95% CI[0.19,0.55],P<0.05)and other complications,also reducing the total complication rate(RR=0.69,95% CI [0.64,0.75],P<0.05);there was no statistically significant difference in complications such as anastomotic leakage,chylothorax,and recurrent laryngeal nerve injury(P≥0.05).Conclusions: Minimally invasive esophagectomy compared with conventional open esophagectomy can reduce the occurrence of postoperative pulmonary infection,arrhythmia,wound infection,total complications and other related complications,but minimally invasive esophagectomy in terms of recurrent nerve injury,anastomotic leakage,chylothorax,larynx did not show significant advantages.