AB036. SOH24AB_009. Open vs. hybrid vs. total laparoscopic minimally invasive vs. robot assisted minimally invasive approaches for esophagectomy for malignancy: a systematic review and network meta-analysis of randomised controlled trials
Clinical Gastrointestinal Session

AB036. SOH24AB_009. Open vs. hybrid vs. total laparoscopic minimally invasive vs. robot assisted minimally invasive approaches for esophagectomy for malignancy: a systematic review and network meta-analysis of randomised controlled trials

Andrew Patton1, Barra O’Byrne1, Matthew Davey1, Eoghain Quinn1, Ciaran Reinhardt1, William Robb2, Noel Donlon1

1Department of Surgery, St. James’s Hospital, Trinity St. James’s Cancer Institute, Trinity College Dublin, Dublin, Ireland; 2Department of Upper Gastrointestinal Surgery, Beaumont Hospital, Dublin, Ireland

Background: Robot assisted minimally invasive esophagectomy (RAMIE) for esophageal carcinoma has emerged as the contemporary alternative to conventional surgical approaches, i.e., totally laparoscopic minimally invasive esophagectomy (TMIE), hybrid esophagectomy (HE) and open esophagectomy (OE). No single study has compared all four approaches with a view to postoperative outcomes.

Methods: A systematic search of electronic databases was undertaken. A network meta-analysis (NMA) was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-NMA guidelines. Statistical analysis was performed using R and Shiny.

Results: Seven randomised control trials (RCTs) with 1,063 patients were included. Overall, 32.9% of patients underwent OE (350/1,063), 11.0% underwent HE (117/1,063), 34.0% of patients underwent TMIE (361/1,063) and 22.1% of patients underwent RAMIE (235/1,063). OE had the lowest anastomotic leak rate 7.7% (27/350), TMIE had the lowest pulmonary 10.8% (39/361), cardiac 0.56% (1/177) complications, reintervention rates 5.08% (12/236), 90-day mortality 1.05% (2/191) and shortest length of hospital stay (mean 11.25 days). RAMIE displayed the lowest 30-day mortality rate at 0.80% (2/250). There was a significant increase in pulmonary complications for those undergoing OE (odds ratio: 3.63, 95% confidence interval: 1.4–9.77) when compared to RAMIE.

Conclusions: TMIE is a safe and feasible option for esophagectomy when compared to OE and HE. The upcoming RCTs will provide further data to make a more robust interrogation of the surgical outcomes following RAMIE compared to conventional open surgery to determine equipoise or superiority of each approach as the era of minimally invasive esophagectomy continues to evolve.

Keywords: Esophagectomy; minimally invasive; open; complications; esophageal cancer

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-24-ab036
Cite this abstract as: Patton A, O’Byrne B, Davey M, Quinn E, Reinhardt C, Robb W, Donlon N. AB036. SOH24AB_009. Open vs. hybrid vs. total laparoscopic minimally invasive vs. robot assisted minimally invasive approaches for esophagectomy for malignancy: a systematic review and network meta-analysis of randomised controlled trials. Mesentery Peritoneum 2024;8:AB036.

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