Does Minimally Invasive Esophagectomy (MIE) Provide for Comparable Oncologic Outcomes to Open Techniques? A Systematic Review

The aim of this study is to compare minimally invasive esophagectomy (MIE) and open techniques with respect to oncologic outcomes through analysis of the extent of lymph node clearance, number of lymph nodes retrieved, oncologic stage, and 5-year mortality. A systematic review of the literature review was conducted using MEDLINE, PubMed, EMBASE, and the Cochrane databases (1950-2011), and evaluated all comparative studies. Comparison between the open and MIE/hybrid MIE (HMIE) groups was possible with data being available for direct comparison. After careful review, 17 case-control studies with 1,586 patients having an esophagectomy were included in this systematic review. The median (range) number of lymph nodes found in the MIE, open and HMIE groups were 16 (5.7-33.90), 10 (3-32.80) and 17 (17-17.15), of which there was significance between the MIE and open groups (p = 0.03) but not significant between MIE versus HMIE (p = 0.25). There was no statistical significance in pathologic stage between open, MIE and HMIE groups. Generally, there were good short-term (30 day) survival rates between all three groups. The open group had 5-year survival rates between 16% and 57% compared to the MIE group 12.5%-63% (p = 0.33). Overall 5-year survival was found to be not significant between open group and MIE (p = 0.93). MIE does not appear on statistical evidence to present any survival advantage. The evidence of this study suggests that MIE is equivalent to standard open esophagectomy in achieving similar oncological outcomes. Further randomised controlled trials are required to provide for a higher level of evidence.