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：

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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.	刘宇英, 魏君丽, 江柔, 等. 食管癌的流行病学及筛查研究进展. 中华疾病控制杂志, 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.	刘庆文, 武强, 唐桂旺, 等. 纵隔镜在食管癌根治术中的研究进展. 中国胸心血管外科临床杂志, 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.	陈椿, 施瑞卿. 微创食管癌切除术与开放食管癌切除术的多中心随机对照研究. 循证医学, 2015, 15(5): 266-267.
12.	王文凭, 何松林, 杨玉赏, 等. 食管癌微创外科手术的现状与思考. 中国胸心血管外科临床杂志, 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.	黄志宁, 柳常青, 郭明发, 等. 充气式纵隔镜联合腹腔镜食管癌切除术的临床分析. 中华外科杂志, 2023, 61(1): 48-53.
15.	柳常青, 吴汉然, 郭明发, 等. 改良充气式纵隔镜在早期胸段食管癌中的临床应用. 中华胸心血管外科杂志, 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.	孙晓冬. 单孔充气式纵隔镜联合腹腔镜与腔镜Mckeown在食管癌治疗中的对比研究. 皖南医学院, 2022.
24.	张广敬, 姜美玲, 张康, 等. 充气式纵隔腔镜与微创McKeown手术治疗食管癌的效果评价. 实用临床医药杂志, 2018, 22(19): 25-28.
25.	杨俊. 改良充气式纵隔镜在早期胸段食管癌中的临床应用. 当代医学, 2021, 27(29): 172-173.
26.	王嘉玮. 单孔充气式纵隔镜联合腹腔镜食管癌根治术治疗食管癌的效果分析. 当代医药论丛, 2020, 18(23): 25-26.
27.	罗德惠, 万翔, 刘际明, 等. 如何实现从样本量、中位数、极值或四分位数到均数与标准差的转换. 中国循证医学杂志, 2017, 17(11): 1350-1356.
28.	王谦, 刘慧兵, 张鲁昌, 等. 单孔充气式纵隔镜辅助经裂孔食管切除术与功能性食管癌切除术的比较: 单中心倾向性评分匹配研究. 中国胸心血管外科临床杂志, 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, 陈子豪, 韦荣强, 等. 充气纵隔镜与电视胸腔镜联合腹腔镜手术治疗食管癌的短期随访结果比较. 中国胸心血管外科临床杂志, 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. 刘宇英, 魏君丽, 江柔, 等. 食管癌的流行病学及筛查研究进展. 中华疾病控制杂志, 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. 刘庆文, 武强, 唐桂旺, 等. 纵隔镜在食管癌根治术中的研究进展. 中国胸心血管外科临床杂志, 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. 陈椿, 施瑞卿. 微创食管癌切除术与开放食管癌切除术的多中心随机对照研究. 循证医学, 2015, 15(5): 266-267.
12. 王文凭, 何松林, 杨玉赏, 等. 食管癌微创外科手术的现状与思考. 中国胸心血管外科临床杂志, 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. 黄志宁, 柳常青, 郭明发, 等. 充气式纵隔镜联合腹腔镜食管癌切除术的临床分析. 中华外科杂志, 2023, 61(1): 48-53.
15. 柳常青, 吴汉然, 郭明发, 等. 改良充气式纵隔镜在早期胸段食管癌中的临床应用. 中华胸心血管外科杂志, 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. 孙晓冬. 单孔充气式纵隔镜联合腹腔镜与腔镜Mckeown在食管癌治疗中的对比研究. 皖南医学院, 2022.
24. 张广敬, 姜美玲, 张康, 等. 充气式纵隔腔镜与微创McKeown手术治疗食管癌的效果评价. 实用临床医药杂志, 2018, 22(19): 25-28.
25. 杨俊. 改良充气式纵隔镜在早期胸段食管癌中的临床应用. 当代医学, 2021, 27(29): 172-173.
26. 王嘉玮. 单孔充气式纵隔镜联合腹腔镜食管癌根治术治疗食管癌的效果分析. 当代医药论丛, 2020, 18(23): 25-26.
27. 罗德惠, 万翔, 刘际明, 等. 如何实现从样本量、中位数、极值或四分位数到均数与标准差的转换. 中国循证医学杂志, 2017, 17(11): 1350-1356.
28. 王谦, 刘慧兵, 张鲁昌, 等. 单孔充气式纵隔镜辅助经裂孔食管切除术与功能性食管癌切除术的比较: 单中心倾向性评分匹配研究. 中国胸心血管外科临床杂志, 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, 陈子豪, 韦荣强, 等. 充气纵隔镜与电视胸腔镜联合腹腔镜手术治疗食管癌的短期随访结果比较. 中国胸心血管外科临床杂志, 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

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