P53 MINIMALLY INVASIVE TECHNIQUES FOR TRANSTHORACIC ESOPHAGECTOMY FOR ESOPHAGEAL CANCERS: A SYSTEMATIC REVIEW AND NETWORK META-ANALYSIS

Abstract Aim To evaluate the clinical outcomes for open, minimally invasive and robotic esophagectomy techniques for esophageal cancers. Background & Methods Esophagectomy is a demanding operation which can be performed by employing different approaches including open surgery or a combination of minimal access techniques. Each approach has specific reported advantages and disadvantages. A systematic literature search was conducted for studies reporting open, laparoscopic hybrid esophagectomy (LHE), thoracoscopic hybrid esophagectomy (THE), totally minimally invasive esophagectomy (MIE) or robotic MIE (RoMIE) for esophagectomy. A network meta-analysis of intraoperative (operating time, blood loss), postoperative (overall complications, anastomotic leaks, chyle leak, length of hospital stay), oncological outcomes (R0 resection, lymphadenectomy) and survival were performed. Results Ninety-eight studies including 32,296 patients were included in the network meta-analysis, of which 55% (n=17824), 5% (n=1576), 7% (n=2421), 30% (n=9558) and 3% (n=917) were open, LHE, THE, MIE and RoMIE respectively. Both MIE and RoMIE were associated with less blood loss, significantly lower rates of pulmonary complications, shorter length of stay and higher lymph node yield. There were no significant differences between surgical techniques for surgical site infections, chyle leak, and 30-day and 90-day mortality. MIE and RoMIE had better 1-year and 5-year survival rates compared to open respectively. Conclusion Minimally invasive and robotic techniques for esophagectomy are associated with reduced perioperative morbidity and length of stay with no compromise on oncological outcomes but no improvement in perioperative mortality. There are suggestions of improved long-term survival with MIE and RoMIE but these associations are not consistent across 1-, 3- and 5-year survival.