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ID: 574 (Conflict of Interest: K)

Meta-Analyse der minimal-invasiven Ösophagektomie verglichen mit dem offenen Verfahren bei Ösophaguskrebs

B. P.Müller, P.Probst, P.Heger, A. T.Billeter, M. K.Diener, T.Schmidt
Universitätsklinikum Heidelberg, Heidelberg

Einleitung

A cornerstone of treatment of esophageal cancer is esophagectomy. Major surgery is performed more and more minimal invasive. The aim of this systematic review and meta-analysis was to summarize evidence for the potential risks and benefits of complete endoscopic (thoracic and abdominal) esophagectomy compared to the open procedure.

Material und Methoden

A systematic literature search from was performed in MEDLINE, Web of Science and CENTRAL without language restrictions. Prospective controlled trials (randomized and non-randomized) comparing minimal invasive esophagectomy with the open procedure were included. Two reviewers independently identified the relevant trials and extracted data on perioperative safety and effectiveness outcomes. Pooled results were displayed as odds ratio (OR) or mean difference (MD) with respective 95% confidence interval (95%-CI).

Ergebnisse

A total of 19 prospective comparative trials were included investigating 2397 esophageal cancer patients. Overall morbidity did not differ between the open and the minimal invasive group (OR 0.81, 95%-CI 0.56 to 1.18). Three outcomes were in favour of the minimal invasive esophagectomy: pneumonia (OR 0.54, 95%-CI 0.34 to 0.84), blood loss (MD −361ml, 95%-CI −514ml to −209m) and 1 year survival rate (OR 1.54, 95%-CI 1.05 to 2.26). The only endpoint in favour of open surgery was operative time (MD 35min, 95%-CI 18min to 52min). Further, short-term and long-term mortality, major complications, reoperations, anastomotic leakages, overall pulmonary complications, length of hospital stay, length of intensive care unit stay, positive resection margin, and number of harvested lymph nodes did not differ between the groups.

Schlussfolgerung

In this set of prospective comparative trials minimal invasive esophagectomy was performed minimally invasive safely and effective compared to the open procedure. The minimal invasive approach was able to avoid pneumonia and had a better 1 year survival rate compared to the open procedure. More randomized trials are needed to increase the quality of the existing evidence.