[Influence of the type of thoracic access on postesophagectomy respiratory complications].
BACKGROUND
A systematic review of the literature was performed with the aim to determine differences in the rate of respiratory complications after esophagectomy for esophageal cancer using minimally invasive access vs traditional thoracic access.


METHODS
A literature search was performed using Medline and Cochrane Library, identifying studies that compared the 2 types of thoracic access, regardless of the type of abdominal access (laparotomy/laparoscopy). The studies selected described respiratory complications in absolute numbers and different categories. Studies that considered minithoracotomy as a minimally invasive technique were excluded. Inclusion criteria were: studies decribing the different types of respiratory complications (9 in total), and analysing the most common complications: respiratory infection, respiratory failure and pleural effusion.


RESULTS
Nine studies were selected (one prospective randomized trial and 8 case control studies) including 1,190 patients, 1,167 of which were operated on for esophageal cancer: 482 patients by thoracotomy and 708 by thoracoscopy. Three studies included definitions of respiratory complications, and one stratified them. The more frequent complications that allowed a meta-analysis were: respiratory infections, pleural effusion, and respiratory failure. No significant differences were found between the 2 types of access in the global analysis.


CONCLUSIONS
The type of thoracic access (thoracotomy or thoracoscopy) does not seem to influence the development of respiratory complications after esophagectomy for cancer. However, the design of the studies analysed, the absence of clear definitions and stratification of the complications makes this conclusion questionable. A consensus on the definition of complications and further prospective randomized clinical trials are necessary.
Servicio de Cirugía General y Digestiva, Hospital de la Santa Creu i Sant Pau, Barcelona, España. Electronic address: mocanu.sorin@gmail.com.
Sorin Niky
SN
Mocanu
M Carmen
MC
Balagué Ponz
Eduardo Maria
EM
Targarona Soler
Marta
M
Roque Figuls
Manel
M
Trias Folch
D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D006801:Humans; D015994:Incidence; D012131:Respiratory Insufficiency / Q000453:epidemiology / Q000209:etiology*; D013907:Thoracostomy / Q000009:adverse effects*; D013908:Thoracotomy / Q000009:adverse effects*
Cirugía mínimamente invasiva; Complicaciones respiratorias; Derrame pleural; Esofagectomía; Esophagectomy; Insuficiencia respiratoria; Minimally invasive surgery; Pleural effusion; Respiratory complications; Respiratory failure; Thoracoscopy; Toracoscopia