title: Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis.
abstract: BACKGROUND
  Open esophagectomy for cancer is a major oncological procedure, associated with significant morbidity and mortality. Recently, thoracoscopic procedures have offered a potentially advantageous alternative because of less operative trauma compared with thoracotomy. The aim of this study was to utilize meta-analysis to compare outcomes of open esophagectomy with those of minimally invasive esophagectomy (MIE) and hybrid minimally invasive esophagectomy (HMIE).
  
  
  METHODS
  Literature search was performed using Medline, Embase, Cochrane Library, and Google Scholar databases for comparative studies assessing different techniques of esophagectomy. A random-effects model was used for meta-analysis, and heterogeneity was assessed. Primary outcomes of interest were 30-day mortality and anastomotic leak. Secondary outcomes included operative outcomes, other postoperative outcomes, and oncological outcomes in terms of lymph nodes retrieved.
  
  
  RESULTS
  A total of 12 studies were included in the analysis. Studies included a total of 672 patients for MIE and HMIE, and 612 for open esophagectomy. There was no significant difference in 30-day mortality; however, MIE had lower blood loss, shorter hospital stay, and reduced total morbidity and respiratory complications. For all other outcomes, there was no significant difference between the two groups.
  
  
  CONCLUSIONS
  Minimally invasive esophagectomy is a safe alternative to the open technique. Patients undergoing MIE may benefit from shorter hospital stay, and lower respiratory complications and total morbidity compared with open esophagectomy. Multicenter, prospective large randomized controlled trials are required to confirm these findings in order to base practice on sound clinical evidence.
authors.affiliation: Imperial College London, London, UK. k.nagpal@imperial.ac.uk
authors.forename: Kamal
authors.initials: K
authors.lastname: Nagpal
authors.forename: Kamran
authors.initials: K
authors.lastname: Ahmed
authors.forename: Amit
authors.initials: A
authors.lastname: Vats
authors.forename: Danny
authors.initials: D
authors.lastname: Yakoub
authors.forename: David
authors.initials: D
authors.lastname: James
authors.forename: Hutan
authors.initials: H
authors.lastname: Ashrafian
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
authors.forename: Krishna
authors.initials: K
authors.lastname: Moorthy
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D013906:Thoracoscopy