1
|
Wang J, Zhao L, Lin J, Yu Y, Tong T, Zhao Y. Comparison of mediastinoscopy and thoracoscope minimally invasive esophagectomy in the treatment of esophageal cancer: a meta-analysis and system review. BMC Cancer 2025; 25:14. [PMID: 39762788 PMCID: PMC11702258 DOI: 10.1186/s12885-024-13307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 12/06/2024] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVE The efficacy and safety of transcervical inflatable mediastinoscopic esophagectomy (TIME) in the treatment of esophageal cancer are unclear. The objective of this meta-analysis was to evaluate the efficacy and safety of TIME treatment for esophageal cancer and to compare it with thoracoscopic assisted minimally invasive esophagectomy (TAMIE) for the treatment of esophageal cancer. METHODS A literature search was performed using PubMed, Embase, and the Cochrane Library to retrieve articles published up to January 2024 to comparatively assess studies of TIME and TAMIE. Meta-analysis was performed using randomized/fixed-effects models and heterogeneity was assessed. RESULTS A total of 819 patients were included in the nine studies herein. Among them, 409 patients with esophageal cancer underwent mediastinoscopy-assisted esophagectomy, and 410 patients with esophageal cancer underwent thoracolaparoscopy-assisted esophagectomy. There was no statistical difference between the TIME and TAMIE groups in intraoperative bleeding, incidence of anastomotic fistula, chylothorax, postoperative bleeding, arrhythmia, postoperative complications and in-hospital mortality. In addition, the operative time in the TIME group, 3-day postoperative induced flux, postoperative hospitalization time, number of lymph node dissection, and incidence of pulmonary complications were smaller than those in the TAMIE group, and the differences were all statistically significant. However, in terms of the incidence of recurrent laryngeal nerve injury (including hoarseness), the TIME group was higher than the TAMIE group. CONCLUSION TIME is a safe and feasible alternative to TAMIE for the treatment of resectable esophageal cancer, but further randomized studies are needed to better assess the long-term benefits of TIME compared with TAMIE.
Collapse
Affiliation(s)
- Jincheng Wang
- Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, China
| | - Linxian Zhao
- Department of General Surgery, The Second Hospital of Jilin University, Changchun, Jilin, 130041, China
| | - Jie Lin
- Department of Hepatobiliary and Pancreatic Surgery, the Second Hospital of Jilin University, Changchun, Jilin, 130000, China
| | - Yating Yu
- Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, China
| | - Ti Tong
- Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, China.
| | - Yinghao Zhao
- Department of Thoracic Surgery, the Second Hospital of Jilin University, Changchun, China.
| |
Collapse
|
2
|
Fujita T, Sato K, Fujiwara N, Kajiyama D, Kubo Y, Daiko H. Robot-assisted cervical esophagectomy with simultaneous transhiatal abdominal procedure for thoracic esophageal carcinoma. Surg Endosc 2024; 38:6413-6422. [PMID: 39225793 PMCID: PMC11525272 DOI: 10.1007/s00464-024-11214-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Minimally invasive robot-assisted cervical esophagectomy has been sporadically reported as a novel thoracic esophagectomy technique for patients with thoracic esophageal carcinoma. Most reports indicate that the abdominal component of robot-assisted cervical esophagectomy is performed sequentially after the cervical phase. However, if the cervical and abdominal phases are performed simultaneously using a nerve integrity monitoring system with no administration of muscle relaxants, there are two major advantages: a reduced risk of recurrent nerve palsy and a shorter operative time. We herein report our experience performing novel robot-assisted transcervical esophagectomy with a simultaneous transhiatal abdominal approach using a nerve integrity monitoring system. METHODS Thirty cases of robot-assisted cervical esophagectomy performed from 2023 to April 2024 were reviewed. The operative and short-term surgical outcomes of this procedure were compared with those of robot-assisted cervical esophagectomy using a sequential abdominal approach, and the feasibility and efficacy of the simultaneous procedure were analyzed. RESULTS All patients successfully underwent robot-assisted cervical esophagectomy with no intraoperative adverse events. There were no differences in the patients' demographic or operative data between the two groups. There was no difference in the mean operation time for the cervical procedure (p = 0.23). However, there was a significant difference in the total time for the whole procedure (sequential group: 453.8 ± 26.8 min, simultaneous group: 291.2 ± 36.1 min; p < 0.01). There were no differences in postoperative surgical complications between the groups. There was also no difference in the total number of surgically harvested mediastinal lymph nodes (p = 0.33). CONCLUSIONS Robot-assisted transcervical esophagectomy, a new technique for thoracic esophageal cancer, was safe and feasible under intraoperative management using nerve integrity monitoring without muscle relaxants. This procedure facilitates intraoperative monitoring of recurrent laryngeal nerve activity, significantly shortening the total operative time.
Collapse
Affiliation(s)
- Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Kazuma Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Naoto Fujiwara
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Daisuke Kajiyama
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuto Kubo
- Division of Esophageal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
3
|
Fang P, Zhou J, Liu Y, Liang Z, Yang Y, Luan S, Xiao X, Li X, Zhang H, Shang Q, Chen L, Zeng X, Yuan Y. Substitute or coexistence? Mediastinoscopy-assisted versus thoracoscope-assisted esophagectomy in esophageal cancer: a meta-analysis of perioperative outcomes and long-term survival. Int J Surg 2024; 110:5802-5817. [PMID: 38869981 PMCID: PMC11392080 DOI: 10.1097/js9.0000000000001777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Currently, mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) represent two prevalent forms of minimally invasive esophagectomy extensively employed in the management of esophageal cancer (EC). The aim of this meta-analysis is to assess and compare these two surgical approaches concerning perioperative outcomes and long-term survival, offering valuable insights for refining surgical strategies and enhancing patient outcomes in this field. METHODS Adhering to PRISMA guidelines, the authors systematically searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI databases until 1 March 2024, for studies comparing MAE and TAE. Outcomes of interest included perioperative outcomes (intraoperative outcomes, postoperative recovery, postoperative complications) and survival rates. Statistical analyses were performed using RevMan 5.4, with heterogeneity dictating the use of fixed or random-effects models. RESULTS A total of 21 relevant studies were finally included. MAE was associated with significantly shorter operation times [mean difference (MD)=-59.58 min, 95% CI: -82.90 to -36.26] and less intraoperative blood loss (MD=-68.34 ml, 95% CI: -130.45 to -6.23). However, MAE resulted in fewer lymph nodes being dissected (MD=-3.50, 95% CI: -6.23 to -0.78). Postoperative recovery was enhanced following MAE, as evidenced by reduced hospital stays and tube times. MAE significantly reduced pulmonary complications [odds ratio (OR)=0.59, 95% CI: 0.44, 0.81] but increased the incidence of recurrent laryngeal nerve injury (OR=1.84, 95% CI: 1.30, 2.60). No significant differences were observed in anastomotic leakage, chylothorax, cardiac complications, wound infections, and gastric retention between MAE and TAE. The long-term survival outcomes showed no statistical difference [hazard ratio (HR)=1.05, 95% CI: 0.71, 1.54]. CONCLUSIONS MAE offers advantages in reducing operation time, blood loss, and specific postoperative complications, particularly pulmonary complications, with a shorter recovery period compared to TAE. However, it poses a higher risk of recurrent laryngeal nerve injury and results in fewer lymph nodes being dissected. No difference in long-term survival was observed, indicating that both techniques have distinct benefits and limitations. These findings underscore the need for personalized surgical approaches in EC treatment, considering individual patient characteristics and tumor specifics.
Collapse
Affiliation(s)
- Pinhao Fang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Jianfeng Zhou
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Yixin Liu
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Zhiwen Liang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Yushang Yang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Siyuan Luan
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Xin Xiao
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Xiaokun Li
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Hanlu Zhang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Qixin Shang
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Longqi Chen
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| | - Xiaoxi Zeng
- West China Biomedical Big Data Center, Med+X Center for Informatics, West China Hospital, Sichuan University, Chengdu, China
| | - Yong Yuan
- Department of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University
| |
Collapse
|
4
|
Fujita T, Sato K, Fujiwara N, Kajiyama D, Shigeno T, Otomo M, Daiko H. Robot-assisted transcervical esophagectomy with a bilateral cervical approach for thoracic esophagectomy. Surg Endosc 2024; 38:1617-1625. [PMID: 38321335 DOI: 10.1007/s00464-024-10692-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/30/2023] [Indexed: 02/08/2024]
Abstract
BACKGROUND Thoracic esophageal cancer resection through the neck approach has recently been reported as mediastinoscopic surgery. We present the first report of a new minimally invasive technique for thoracic esophageal cancer: robot-assisted transcervical esophagectomy with a bilateral cervical approach. METHODS Ten cases of robot-assisted bilateral transcervical esophagectomy performed at the National Cancer Center Hospital East, Japan, from February 2023 to August 2023 were reviewed. The short-term surgical outcomes were presented, and the feasibility and efficacy of this procedure were discussed. RESULTS The mean operation time for the cervical procedure was 184.2 ± 23.6 min. The total time for the whole procedure was 472.7 ± 28.4 min, and total intraoperative blood loss was 162.2 ± 40.0 ml. Among the 10 cases, one patient developed recurrent nerve paralysis, one patient developed pulmonary complications, and no patients developed postoperative pneumonia. The median postoperative hospital stay was 22 (range: 12-43) days. No patients developed severe postoperative surgical complications, which were graded as Clavien-Dindo ≥ III. The total number of surgically harvested mediastinal lymph nodes was 37.2 ± 11.2. CONCLUSIONS Robot-assisted bilateral transcervical esophagectomy, a novel procedure for thoracic esophageal cancer, was safe and feasible. Using this procedure, the incidence of recurrent nerve palsy, which is a problem with transcervical esophagectomy and mediastinoscopic esophagectomy, is expected to decrease.
Collapse
Affiliation(s)
- Takeo Fujita
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
| | - Kazuma Sato
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Naoto Fujiwara
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Daisuke Kajiyama
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Takashi Shigeno
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Mayuko Otomo
- Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Hiroyuki Daiko
- Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan
| |
Collapse
|
5
|
Song S, Shen C, Hu Y, He Y, Yuan Y, Xu Y. Application of Inflatable Video-Assisted Mediastinoscopic Transhiatal Esophagectomy in Individualized Treatment of Esophageal Cancer. Biomedicines 2023; 11:2750. [PMID: 37893123 PMCID: PMC10603894 DOI: 10.3390/biomedicines11102750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 09/08/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023] Open
Abstract
Surgery is a crucial treatment option for patients with resectable esophageal cancer. The emergence of minimally invasive esophageal techniques has led to the popularity of video-assisted thoracoscopic esophagectomy, which has proven to be more advantageous than traditional thoracotomy. However, some patients with esophageal cancer may not benefit from this procedure. Individualized treatment plans may be necessary for patients with varying conditions and tolerances to anesthesia, making conventional surgical methods unsuitable. Inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) has emerged as a promising treatment option for esophageal cancer because it does not require one-lung ventilation, reduces postoperative complications, and expands surgical indications. This technique also provides surgical opportunities for patients with impaired pulmonary function or thoracic lesions. It is crucial to have a comprehensive understanding of the advancements and limitations of IVMTE to tailor treatment plans and improve outcomes in patients with esophageal cancer. Understanding the advantages and limitations of this surgical method will help specific patients with esophageal cancer. We conducted a thorough review of the relevant literature to examine the importance of IVMTE for individualized treatment of this disease.
Collapse
Affiliation(s)
- Shangqi Song
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Cheng Shen
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Yazhou He
- Usher Institute of Population Health Sciences, The University of Edinburgh, Edinburgh EH8 9YL, UK
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| | - Yuyang Xu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu 610041, China; (S.S.)
| |
Collapse
|
6
|
Dabsha A, Elkharbotly IAMH, Yaghmour M, Badr A, Badie F, Khairallah S, Esmail YM, Shmushkevich S, Hossny M, Rizk A, Ishak A, Wright J, Mohamed A, Rahouma M. Novel Mediastinoscope-Assisted Minimally Invasive Esophagectomy for Esophageal Cancer: A Systematic Review and Meta-analysis. Ann Surg Oncol 2023; 30:4030-4039. [PMID: 36820939 DOI: 10.1245/s10434-023-13264-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND Minimally invasive surgery is an expanding field of surgery that has replaced many open surgical techniques. Surgery remains a cornerstone in the treatment of esophageal cancer, yet it is still associated with significant morbidity and technical difficulties. Mediastinoscope-assisted esophagectomy is a promising technique that aims to decrease the surgical burden and enhance recovery. METHODS PubMed, MEDLINE, and EMBASE databases were searched for publications on mediastinoscope-assisted esophagectomies for esophageal cancer. The primary endpoint was a postoperative anastomotic leak, while secondary endpoints were assessment of harvested lymph nodes (LNs), blood loss, chyle leak, hospital length of stay (LOS), operative (OR) time, pneumonia, wound infection, mortality, and microscopic positive margin (R1). The pooled event rate (PER) and pooled mean were calculated for binary and continuous outcomes respectively. RESULTS Twenty-six out of the 2274 searched studies were included. The pooled event rate (PER) for anastomotic leak was 0.145 (0.1144; 0.1828). The PERs for chyle leak, recurrent laryngeal nerve injury/hoarseness, postoperative pneumonia, wound infection, early mortality, postoperative morbidity, and microscopically positive (R1) resection margins were 0.027, 0.185, 0.09, 0.083, 0.020, 0.378, and 0.037 respectively. The pooled means for blood loss, hospital stay, operative time, number of total harvested LNs, and number of harvested thoracic LNs were 159.209, 15.187, 311.116, 23.379, and 15.458 respectively. CONCLUSIONS Mediastinoscopic esophagectomy is a promising minimally invasive technique, avoiding thoracotomy, patient repositioning, and lung manipulation; thus allowing for shorter surgery, decreased blood loss, and decreased postoperative morbidity. It can also be reliable in terms of oncological safety and LN dissection.
Collapse
Affiliation(s)
- Anas Dabsha
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Ismail A M H Elkharbotly
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
- General Surgery Department, Newham University Hospital, London, UK
| | - Mohammad Yaghmour
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
| | - Amr Badr
- El Ruwaisat Family Medical Center, Sharm Elsheikh, Egypt
| | - Fady Badie
- General Surgery Department, Kasr Al-ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Sherif Khairallah
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Yomna M Esmail
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
| | - Shon Shmushkevich
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
| | - Mohamed Hossny
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
| | - Amr Rizk
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Amgad Ishak
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
| | - Jessica Wright
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA
| | - Abdelrahman Mohamed
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mohamed Rahouma
- Cardiothoracic Surgery Department, Weill Cornell Medicine, New York, NY, USA.
- Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt.
| |
Collapse
|