Evidence to support the use of minimally invasive esophagectomy for esophageal cancer: a meta-analysis.

OBJECTIVE To use meta-analysis to compare oncologic outcomes of minimally invasive esophagectomy (MIE) with open techniques (thoracoscopic and/or laparoscopic). Analysis includes the extent of lymph node (LN) clearance, number of LNs retrieved, staging, geographic variance, and mortality. DATA SOURCES A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines using MEDLINE, PubMed, EMBASE, and the Cochrane databases (1950-2012). We evaluated all comparative studies. STUDY SELECTION All eligible published studies with adequate oncologic data comparing MIE with open resection for carcinoma of the esophagus or esophagogastric junction. DATA EXTRACTION Two investigators independently selected studies for inclusion and exclusion by article abstraction and quality assessment. DATA SYNTHESIS After careful review, we included 16 case-control studies with 1212 patients undergoing esophagectomy. The median (range) number of LNs found in the MIE and open groups were 16 (5.7-33.9) and 10 (3.0-32.8), respectively, with a significant difference favoring MIE (P = .04). In comparing LN retrieval in Eastern vs Western studies, we found a significant difference in Western centers favoring MIE (P < .001). No statistical significance in pathologic staging was found between the open and MIE groups. Generally, no statistically significant difference was found between the open and MIE groups for survival within each time interval (30 days and 1, 2, 3, and 5 years), although the difference favored the MIE group. In comparing survival outcomes in Eastern vs Western centers, a nonsignificant survival advantage (across all time intervals) was found for MIE in the Eastern (P = .28) and Western (P = .44) centers. CONCLUSIONS Minimally invasive esophagectomy is a viable alternative to open techniques. Meta-analytic evidence finds equivalent oncologic outcomes to conventional open esophagectomy.