Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis

Background: Open esophagectomy (OE) is associated with significant morbidity and mortality. Minimally invasive oesophagectomy (MIO) reduces complications in resectable esophageal cancer. The aim of this study is to explore the superiority of MIO in reducing complications and in-hospital mortality than OE. Methods: MEDLINE, Embase, Science Citation Index, Wanfang, and Wiley Online Library were thoroughly searched. Odds ratio (OR)/weighted mean difference (WMD) with a 95% confidence interval (CI) was used to assess the strength of association. Results: Fifty-seven studies containing 15,790 cases of resectable esophageal cancer were included. MIO had less intraoperative blood loss, short hospital stay, and high operative time (P < 0.05) than OE. MIO also had reduced incidence of total complications; (OR = 0.700, 95% CI = 0.626 similar to 0.781, P-V < 0.05), pulmonary complications (OR = 0. 527, 95% CI = 0431 similar to 0.645, P-V < 0.05), cardiovascular complications (OR = 0.770, 95% CI = 0.681 similar to 0.872, P-V < 0.05), and surgical technology related (STR) complications (OR = 0.639, 95% CI = 0.522 similar to 0.781, P-V < 0.05), as well as lower in-hospital mortality (OR = 0.668, 95% CI = 0.539 similar to 0.827, P-V < 0.05). However, the number of harvested lymph nodes, intensive care unit (ICU) stay, gastrointestinal complications, anastomotic leak (AL), and recurrent laryngeal nerve palsy (RLNP) had no significant difference. Conclusions: MIO is superior to OE in terms of perioperative complications and in-hospital mortality.