title: Superiority of Minimally Invasive Oesophagectomy in Reducing In-Hospital Mortality of Patients with Resectable Oesophageal Cancer: A Meta-Analysis.
abstract: BACKGROUND
  Compared with open oesophagectomy (OE), minimally invasive oesophagectomy (MIO) proves to have benefits in reducing the risk of pulmonary complications for patients with resectable oesophageal cancer. However, it is unknown whether MIO has superiority in reducing the occurrence of in-hospital mortality (IHM).
  
  
  OBJECTIVE
  The objective of this meta-analysis was to explore the effect of MIO vs. OE on the occurrence of in-hospital mortality (IHM).
  
  
  METHODS
  Sources such as Medline (through December 31, 2014), Embase (through December 31, 2014), Wiley Online Library (through December 31, 2014), and the Cochrane Library (through December 31, 2014) were searched.
  
  
  METHODS
  Data of randomized and non-randomized clinical trials related to MIO versus OE were included.
  
  
  METHODS
  Eligible studies were those that reported patients who underwent MIO procedure. The control group included patients undergoing conventional OE.
  
  
  METHODS
  Fixed or random -effects models were used to calculate summary odds ratios (ORs) or relative risks (RRs) for quantification of associations. Heterogeneity among studies was evaluated by using Cochran's Q and I2 statistics.
  
  
  RESULTS
  A total of 48 studies involving 14,311 cases of resectable oesophageal cancer were included in the meta-analysis. Compared to patients undergoing OE, patients undergoing MIO had statistically reduced occurrence of IHM (OR=0.69, 95%CI =0.55 -0.86). Patients undergoing MIO also had significantly reduced incidence of pulmonary complications (PCs) (RR=0.73, 95%CI = 0.63-0.86), pulmonary embolism (PE) (OR=0.71, 95%CI= 0.51-0.99) and arrhythmia (OR=0.79, 95%CI = 0.68-0.92). Non-significant reductions were observed among the included studies in the occurrence of anastomotic leak (AL) (OR=0.93, 95%CI =0.78-1.11), or Gastric Tip Necrosis (GTN) (OR=0.89, 95%CI =0.54-1.49).
  
  
  CONCLUSIONS
  Most of the included studies were non-randomized case-control studies, with a diversity of study designs, demographics of participants and surgical intervention.
  
  
  CONCLUSIONS
  Minimally invasive oesophagectomy (MIO) has superiority over open oesophagectomy (OE) in terms of the occurrence of in-hospital mortality (IHM) and should be the first-choice surgical procedure in esophageal surgery.
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Can
authors.initials: C
authors.lastname: Zhou
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Li
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Xiaoxia
authors.initials: X
authors.lastname: Ma
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Bohui
authors.initials: B
authors.lastname: Shi
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Wuke
authors.initials: W
authors.lastname: Chen
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Jianjun
authors.initials: J
authors.lastname: He
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Ke
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Translational Medicine Center, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
authors.forename: Peijun
authors.initials: P
authors.lastname: Liu
authors.affiliation: Department of Breast Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shan'xi Province, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Ren
mesh_terms: D057868:Anastomotic Leak; D001145:Arrhythmias, Cardiac / Q000150:complications; D002986:Clinical Trials as Topic; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods* / Q000401:mortality*; D004947:Esophagus / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality*; D009336:Necrosis / Q000473:pathology; D016017:Odds Ratio; D012306:Risk; D016896:Treatment Outcome