title: Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: a meta-analysis.
abstract: OBJECTIVE
  To compare the efficacy and safety of the transthoracic and transhiatal approaches for cancer of the esophagogastric junction.
  
  
  METHODS
  An electronic and manual search of the literature was conducted in PubMed, EmBase and the Cochrane Library for articles published between March 1998 and January 2013. The pooled data included the following parameters: duration of surgical time, blood loss, dissected lymph nodes, hospital stay time, anastomotic leakage, pulmonary complications, cardiovascular complications, 30-d hospital mortality, and long-term survival. Sensitivity analysis was performed by excluding single studies.
  
  
  RESULTS
  Eight studies including 1155 patients with cancer of the esophagogastric junction, with 639 patients in the transthoracic group and 516 in the transhiatal group, were pooled for this study. There were no significant differences between two groups concerning surgical time, blood loss, anastomotic leakage, or cardiovascular complications. Dissected lymph nodes also showed no significant differences between two groups in randomized controlled trials (RCTs) and non-RCTs. However, we did observe a shorter hospital stay (WMD = 1.92, 95%CI: 1.63-2.22, P < 0.00001), lower 30-d hospital mortality (OR = 3.21, 95%CI: 1.13-9.12, P = 0.03), and decreased pulmonary complications (OR = 2.95, 95%CI: 1.95-4.45, P < 0.00001) in the transhiatal group. For overall survival, a potential survival benefit was achieved for type III tumors with the transhiatal approach.
  
  
  CONCLUSIONS
  The transhiatal approach for cancers of the esophagogastric junction, especially types III, should be recommended, and its long-term outcome benefits should be further evaluated.
authors.affiliation: Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ming-Tian
authors.initials: MT
authors.lastname: Wei
authors.affiliation: Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yuan-Chuan
authors.initials: YC
authors.lastname: Zhang
authors.affiliation: Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Xiang-Bing
authors.initials: XB
authors.lastname: Deng
authors.affiliation: Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ting-Han
authors.initials: TH
authors.lastname: Yang
authors.affiliation: Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ya-Zhou
authors.initials: YZ
authors.lastname: He
authors.affiliation: Ming-Tian Wei, Yuan-Chuan Zhang, Xiang-Bing Deng, Ting-Han Yang, Ya-Zhou He, Zi-Qiang Wang, Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Zi-Qiang
authors.initials: ZQ
authors.lastname: Wang
mesh_terms: D016063:Blood Loss, Surgical / Q000401:mortality; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004943:Esophagogastric Junction / Q000473:pathology / Q000601:surgery*; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D008197:Lymph Node Excision; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016019:Survival Analysis; D019616:Thoracic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cancer of the esophagogastric junction; Meta-analysis; Transhiatal surgery; Transthoracic surgery
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