| Objective The meta-analysis was used to explore the difference of short-term efficacy between endoscopic radical resection of esophageal cancer and open resection of esophageal cancer in the treatment of esophageal carcinoma,so as to provide more reliable and stable evidence for clinical practice.Methods By studying the method of evidence-based medicine and the Cochrane Handbook system evaluation standard,the English databases of PubMed,Embase,The Cochrane Library,Web of Science,Chinese Biomedical Literature Database,CNKI,Weipu and Wanfang databases were searched online according to the predetermined Chinese and English search terms from their date of inception to January 2021 to collect the randomized controlled trials research about comparison of short-term curative effect on the treatment of esophageal malignant tumor between endoscopic radical resection of esophageal cancer and open resection of esophageal cancer.Literature screening was conducted in strict accordance with inclusion and exclusion criteria,and relevant data of the final included studies were extracted.The methods for assessing the quality of the literature provided in the Cochrane website manual and modified Jadad score were used to evaluate the quality of the included literatures.Meta-analysis was performed using Rev Man 5.3 software.Results Through database literature retrieval,screening and quality evaluation,25 studies were included,all of which were randomized controlled trials(RCTs)with a total of3512 patients,including 1750 patients in the endoscopic radical resection of esophageal cancer group and 1762 patients in the open esophagectomy(OE)group.The results of meta-analysis showed that the perioperative morbidity of OE group was significantly higher than that of endoscopic group [RR=0.42,95%CI(0.36,0.48),P<0.00001].In the endoscopic group,the rate of postoperative respiratory complications(RCs)[RR=0.39,95%CI(0.31,0.49),P<0.00001],cardiac complications(CCs)[RR = 0.57,95% CI(0.34,0.93),P =0.03],anastomotic fistula(AL)[RR=0.61,95%CI(0.43,0.88),P = 0.007)],laryngeal recurrent nerve injury [RR = 0.37,95% CI(0.21,0.65),P = 0.0005],gastric emptying disorder [RR =0.47,95% CI(0.26,0.86),P = 0.01] and incision infection [RR = 0.28,95% CI(0.13,0.62),P= 0.002]were lower than that in the OE group.And there was no significant statistical difference in chylothorax [RR = 0.64,95% CI(0.34,1.20),P = 0.16],30-day mortality[RR=0.99,95%CI(0.17,5.68),P=0.99] and reoperation rate[RR=0.80,95%CI(0.41,1.59),P=0.53]between the two groups.And the intraoperative blood loss[SMD=-2.81,95% CI(-3.48,-2.15),P<0.00001],the length of stay(LOS)postoperatively[SMD =-1.59,95% CI(-1.98,-1.20),P<0.00001],postoperative drainage time [SMD =-1.28,95% CI(-1.76,-0.80),P<0.00001],the volume of drainage[SMD =-7.23,95% CI(-9.73,-4.72),P<0.00001] and the number of lymph node cleaning [SMD = 0.40,95% CI(0.07,0.73),P = 0.02] of endoscopic group were superior to OE group.And there was no statistically difference in operation time[SMD=0.06,95%CI(-0.50,0.62),P=0.83] between two groups.Conclusion Compared with open esophagectomy,endoscopic radical resection of esophageal cancer has significantly better short-term efficacy in the treatment of esophageal malignant tumors and a lower incidence of postoperative complications,which is conducive to postoperative rehabilitation and improvement of the quality of life of patients. |
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