A Systematic Review And Meta-Analysis Of The Safety And Efficacy Of MATHE And TATTE In The Treatment Of Esophageal Tumors

Objective:At present,thoracoscopic assisted esophageal cancer resection(TATTE)is one of the mainstream methods of minimally invasive treatment of esophageal cancer,while mediastinoscopic assisted esophageal cancer resection(MATHE)has limited clinical application.Meta-analysis was used to objectively evaluate the intraoperative and postoperative conditions and related complications of mediastinoscopic-assisted and thoracoscopic surgery for esophageal tumors,so as to further analyze and evaluate the safety and efficacy of two different surgical methods of mediastinoscopy-assisted and thoracoscopically assisted esophageal tumor resection in the treatment of esophageal tumors.Method:Computer searches Pub Med,Em Base,Web of Science,Wanfang Data,Vip Database(VIP),CNKI to obtain all published Chinese and English literature on the comparative study of mediastinoscopy-assisted and thoracoscopic surgery for esophageal tumors,the types of literature studies were randomized controlled studies,case-control studies,and cohort studies,and the search time limit is December 2022,Search keywords: esophageal cancer,mediastinoscopy,eso Phageal cancer,Mediastinosco,etc.According to the set inclusion and exclusion criteria,two different boffin screened literature,extracted data and assessed quality independently,Outcome indicators included time required for surgery,intraoperative blood loss,total drainage volume at 3days postoperatively,length of postoperative hospital stay,etc,and NOS scale was used for literature quality evaluation,cross-checked,and meta-analysed the relevant outcomes screened for inclusion in this study using Rev Man 5.4 software,Study effect sizes,confidence intervals and publication bias were assessed by plotting forest and funnel plots.Result:Through the search,15 articles were screened and included a total of 1242 patients,including 590 cases in the mediastinoscopic assisted surgery group and 652 cases in the thoracoscopic assisted surgery group.According to the results of meta-analysis,there was no significant significance in male sex structure and age bracket between MATHE group and the TATTE group(P>0.05).Compared with the thoracoscopic assisted surgery group,the time required for surgery was shortened(WMD=-65.10,95%CI-85.79~-44.41,P<0.001)),the total intraoperative bleeding increased in the mediastoscopic group after subgroup analysis(WMD=134.86,95%CI 28.03~241.68,P=0.01),and the total intraoperative bleeding decreased in the modified inflatable mediastinoscopy group(WMD=-51.20,95%CI-73.68~-28.72,P<0.0001),total drainage decreased 3 days after surgery(WMD=-389.59,95%CI-521.40~-257.78,P<0.001);The total length of postoperative hospitalization was shortened(WMD=-2.54,95%CI-3.11~-1.98,P<0.001),and postoperative pulmonary infections were reduced(OR=0.45,95%CI 0.30~0.67,P <0.0001)),decreased chylothorax after surgery(OR=0.36,95% CI 0.16~0.78,P=0.01),increased postoperative recurrent laryngeal nerve injury(OR=2.22,95%CI1.46~3.37,P=0.0002),but it showed that there was no significant differences in the number of lymph node dissections,postoperative complicated anastomotic fistula,postoperative complicated arrhythmias,and postoperative complicated oral malhealing(P>0.05).Conclusion:Compared with thoracoscopy-assisted surgery group,the intraoperative time of patients was significantly shortened in esophageal cancer resection surgery,which could reduce the incidence of postoperative pulmonary infection and chylofistula,reduce the total drainage volume 3 days after surgery,and shorten the total length of hospitalization,and after subgroup analysis,the total intraoperative bleeding in the non-pneumatic mediastinoscopy group increased the total intraoperative bleeding compared with the thoracoscopy-assisted surgery group,and the total intraoperative bleeding in the modified gas-filled mediastinoscope-assisted surgery group was reduced compared with the thoracoscopy-assisted surgery group.Although it is at a disadvantage in postoperative recurrent laryngeal nerve injury,there is no significant difference in the number of lymph node dissection during surgery,postoperative anastomotic fistula,postoperative complicated arrhythmia,and postoperative complicated oral malhealing.