Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction:A meta-analysis

AIM:To compare the efficacy and safety of the transthoracic and transhiatal approaches for cancer of the esophagogastric junction.METHODS:An electronic and manual search of the literature was conducted in PubMed,EmBase and the Cochrane Library for articles published between March1998 and January 201...

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Published in:World journal of gastroenterology : WJG 2014-08, Vol.20 (29), p.10183-10192
Main Authors: Wei, Ming-Tian, Zhang, Yuan-Chuan, Deng, Xiang-Bing, Yang, Ting-Han, He, Ya-Zhou, Wang, Zi-Qiang
Format: Article
Language:English
Subjects:
Blood Loss, Surgical - mortality
Cancer
Chi-Square Distribution
Esophageal Neoplasms - mortality
Esophageal Neoplasms - pathology
Esophageal Neoplasms - surgery
Esophagectomy - adverse effects
Esophagectomy - methods
Esophagectomy - mortality
Esophagogastric Junction - pathology
Esophagogastric Junction - surgery
Gastrectomy - adverse effects
Gastrectomy - methods
Gastrectomy - mortality
Hospital Mortality
Humans
Lymph Node Excision
Meta-Analysis
Odds Ratio
Postoperative Complications - mortality
Risk Factors
Stomach Neoplasms - mortality
Stomach Neoplasms - pathology
Stomach Neoplasms - surgery
surgery
Survival Analysis
Thoracic Surgical Procedures - adverse effects
Thoracic Surgical Procedures - mortality
Time Factors
Transhiatal
Transthoracic
Treatment Outcome
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Summary:AIM:To compare the efficacy and safety of the transthoracic and transhiatal approaches for cancer of the esophagogastric junction.METHODS:An electronic and manual search of the literature was conducted in PubMed,EmBase and the Cochrane Library for articles published between March1998 and January 2013.The pooled data included the following parameters:duration of surgical time,blood loss,dissected lymph nodes,hospital stay time,anastomotic leakage,pulmonary complications,cardiovascular complications,30-d hospital mortality,and long-term survival.Sensitivity analysis was performed by excluding single studies.RESULTS:Eight studies including 1155 patients with cancer of the esophagogastric junction,with 639 patients in the transthoracic group and 516 in the transhiatal group,were pooled for this study.There were no significant differences between two groups concerning surgical time,blood loss,anastomotic leakage,or cardiovascular complications.Dissected lymph nodes also showed no significant differences between two groups in randomized controlled trials(RCTs)and nonRCTs.However,we did observe a shorter hospital stay(WMD=1.92,95%CI:1.63-2.22,P<0.00001),lower30-d hospital mortality(OR=3.21,95%CI:1.13-9.12,P=0.03),and decreased pulmonary complications(OR=2.95,95%CI:1.95-4.45,P<0.00001)in the transhiatal group.For overall survival,a potential survival benefit was achieved for typeⅢtumors with the transhiatal approach.CONCLUSION:The transhiatal approach for cancers of the esophagogastric junction,especially typesⅢ,should be recommended,and its long-term outcome benefits should be further evaluated.
ISSN:1007-9327
2219-2840
DOI:10.3748/wjg.v20.i29.10183