Abstract：
BACKGROUND: Transhiatal esophagectomy (THE) avoids thoracotomy but sacrifices mediastinal lymphadenectomy. Mediastinoscopy-assisted transhiatal esophagectomy (MATHE) allows for visualisation and en-bloc dissection of mediastinal lymph nodes while retaining the benefits of THE. However, given its novel inception, there is a paucity of literature. This study aimed to conduct the first meta-analysis to explore the efficacy of MATHE and clarify its role in the future of esophagectomy.
METHODS: Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to May 1, 2023. Studies were included if they reported outcomes for patients with esophageal cancer who underwent MATHE. Meta-analyses of proportions and pooled means were performed for the outcomes of intraoperative blood loss, lymph node (LN) harvest, mean hospital length of stay (LOS), mean operative time, R0 resection, conversion rates, 30-day mortality rate, 5-year OS, and surgical complications (anastomotic leak, cardiovascular [CVS] and pulmonary complications, chyle leak and recurrent laryngeal nerve palsy [RLN]). Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity.
RESULTS: The search yielded 223 articles; 28 studies and 1128 patients were included in our analysis. Meta-analyses of proportions yielded proportion rates: 30-day mortality (0 %, 95 %CI 0-0), 5-year OS (60.5 %, 95 %CI 47.6-72.7), R0 resection (100 %, 95 %CI 99.3-100), conversion rate (0.1 %, 95 %CI 0-1.2). Among surgical complications, RLN palsy (14.6 %, 95 %CI 9.5-20.4) were most observed, followed by pulmonary complications (11.3 %, 95 %CI 7-16.2), anastomotic leak (9.7 %, 95 %CI 6.8-12.8), CVS complications (2.3 %, 95 %CI 0.9-4.1) and chyle leak (0.02 %, 95 %CI 0-0.8). Meta-analysis of pooled means yielded means: LN harvest (18.6, 95 %CI 14.3-22.9), intraoperative blood loss (247.1 ml, 95 %CI 173.6-320.6), hospital LOS (18.1 days, 95 %CI 14.4-21.8), and operative time (301.5 min, 95 %CI 238.4-364.6). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses.
CONCLUSIONS: MATHE is associated with encouraging post-operative mortality and complication rates, while allowing for radical mediastinal lymphadenectomy with reasonable lymph node harvest.
METHODS: Four databases (PubMed, EMBASE, Scopus, and Cochrane Library) were searched from inception to May 1, 2023. Studies were included if they reported outcomes for patients with esophageal cancer who underwent MATHE. Meta-analyses of proportions and pooled means were performed for the outcomes of intraoperative blood loss, lymph node (LN) harvest, mean hospital length of stay (LOS), mean operative time, R0 resection, conversion rates, 30-day mortality rate, 5-year OS, and surgical complications (anastomotic leak, cardiovascular [CVS] and pulmonary complications, chyle leak and recurrent laryngeal nerve palsy [RLN]). Sensitivity analyses were performed for outcomes with substantial statistical heterogeneity.
RESULTS: The search yielded 223 articles; 28 studies and 1128 patients were included in our analysis. Meta-analyses of proportions yielded proportion rates: 30-day mortality (0 %, 95 %CI 0-0), 5-year OS (60.5 %, 95 %CI 47.6-72.7), R0 resection (100 %, 95 %CI 99.3-100), conversion rate (0.1 %, 95 %CI 0-1.2). Among surgical complications, RLN palsy (14.6 %, 95 %CI 9.5-20.4) were most observed, followed by pulmonary complications (11.3 %, 95 %CI 7-16.2), anastomotic leak (9.7 %, 95 %CI 6.8-12.8), CVS complications (2.3 %, 95 %CI 0.9-4.1) and chyle leak (0.02 %, 95 %CI 0-0.8). Meta-analysis of pooled means yielded means: LN harvest (18.6, 95 %CI 14.3-22.9), intraoperative blood loss (247.1 ml, 95 %CI 173.6-320.6), hospital LOS (18.1 days, 95 %CI 14.4-21.8), and operative time (301.5 min, 95 %CI 238.4-364.6). There was moderate-to-high statistical heterogeneity. Findings were robust to sensitivity analyses.
CONCLUSIONS: MATHE is associated with encouraging post-operative mortality and complication rates, while allowing for radical mediastinal lymphadenectomy with reasonable lymph node harvest.
摘要：
背景：经食管切除术（THE）避免了开胸手术，但牺牲了纵隔淋巴结清扫术。纵隔镜检查辅助的横道食管切除术（MATHE）允许纵隔淋巴结的可视化和整体解剖，同时保留了THE的益处。然而,鉴于其新颖的开始，文学匮乏。本研究旨在进行首次荟萃分析，以探讨MATHE的疗效并阐明其在未来食管癌切除术中的作用。
方法：四个数据库(PubMed，EMBASE,Scopus,和Cochrane图书馆)从成立到2023年5月1日进行了搜索。如果研究报告了接受MATHE的食道癌患者的预后，则纳入研究。对术中失血的结果进行比例和合并均值的荟萃分析，淋巴结（LN）收获，平均住院时间（LOS），平均手术时间，R0切除,转化率，30天死亡率,5年操作系统,和手术并发症(吻合口漏，心血管[CVS]和肺部并发症，乳糜漏和喉返神经麻痹[RLN])。对具有实质性统计异质性的结果进行敏感性分析。
结果：我们的分析中包含了223篇文章；28项研究和1128例患者。比例的荟萃分析得出比例率：30天死亡率(0%，95CI0-0），5年OS（60.5%，95CI47.6-72.7)，R0切除（100%，95CI99.3-100)，转化率(0.1%，95CI0-1.2）。在手术并发症中，RLN麻痹（14.6%，95CI9.5-20.4)观察最多，其次是肺部并发症（11.3%，95CI7-16.2)，吻合口漏（9.7％，95CI6.8-12.8)，CVS并发症（2.3%，95CI0.9-4.1)和乳糜渗漏(0.02%，95CI0-0.8）。汇总平均值的荟萃分析产生平均值：LN收获（18.6，95CI14.3-22.9），术中失血量（247.1ml，95CI173.6-320.6)，医院LOS（18.1天，95CI14.4-21.8)，和手术时间(301.5min,95CI238.4-364.6）。存在中度到高度的统计异质性。研究结果对敏感性分析是稳健的。
结论：MATHE与令人鼓舞的术后死亡率和并发症发生率相关，同时允许根治性纵隔淋巴结清扫术和合理的淋巴结收获。
方法：四个数据库(PubMed，EMBASE,Scopus,和Cochrane图书馆)从成立到2023年5月1日进行了搜索。如果研究报告了接受MATHE的食道癌患者的预后，则纳入研究。对术中失血的结果进行比例和合并均值的荟萃分析，淋巴结（LN）收获，平均住院时间（LOS），平均手术时间，R0切除,转化率，30天死亡率,5年操作系统,和手术并发症(吻合口漏，心血管[CVS]和肺部并发症，乳糜漏和喉返神经麻痹[RLN])。对具有实质性统计异质性的结果进行敏感性分析。
结果：我们的分析中包含了223篇文章；28项研究和1128例患者。比例的荟萃分析得出比例率：30天死亡率(0%，95CI0-0），5年OS（60.5%，95CI47.6-72.7)，R0切除（100%，95CI99.3-100)，转化率(0.1%，95CI0-1.2）。在手术并发症中，RLN麻痹（14.6%，95CI9.5-20.4)观察最多，其次是肺部并发症（11.3%，95CI7-16.2)，吻合口漏（9.7％，95CI6.8-12.8)，CVS并发症（2.3%，95CI0.9-4.1)和乳糜渗漏(0.02%，95CI0-0.8）。汇总平均值的荟萃分析产生平均值：LN收获（18.6，95CI14.3-22.9），术中失血量（247.1ml，95CI173.6-320.6)，医院LOS（18.1天，95CI14.4-21.8)，和手术时间(301.5min,95CI238.4-364.6）。存在中度到高度的统计异质性。研究结果对敏感性分析是稳健的。
结论：MATHE与令人鼓舞的术后死亡率和并发症发生率相关，同时允许根治性纵隔淋巴结清扫术和合理的淋巴结收获。
