Effect of en bloc esophagectomy and total meso-esophagectomy on esophageal cancer patients: a systematic review and meta-analysis

AME medical journal Pub Date : 2022-09-01 DOI:10.21037/amj-22-38

Feng Su, Heng Jiao, Jun Yin, Yong Fang, L. Tan, Yaxing Shen

{"title":"Effect of en bloc esophagectomy and total meso-esophagectomy on esophageal cancer patients: a systematic review and meta-analysis","authors":"Feng Su, Heng Jiao, Jun Yin, Yong Fang, L. Tan, Yaxing Shen","doi":"10.21037/amj-22-38","DOIUrl":null,"url":null,"abstract":"Background: Esophagectomy offers the chance of cure for esophageal cancer, however, the optimal circumferential extent of surgery remains uncertain. Yet, the practice of en bloc esophagectomy (EBE) and meso-esophagectomy (TME) reached inconsistent results, which led to the proposal of this study was to evaluate the surgical and oncological effect of EBE and TME on the esophageal cancer patients. Methods: Five databases were searched through March 1st, 2022, and the references of eligible studies were further searched in the databases and assessed. Randomized controlled trials (RCTs) comparing the e�cacy of EBE or TME were included. The outcomes were recorded in the forms of mean difference (MD), risk ratio (RR), odds ratio (OR) and hazard ratio (HR) with its corresponding 95% con�dence intervals (CI). Results: Overall, a total of 14 RCTs involving 3106 subjects were included. Compared with standard resection, a higher blood loss (MD=56.29, (14.80, 97.77), P=0.008), more lymph nodes acquired (MD=14.39, (9.79, 19.00), P<0.001) and better long-term outcomes for early (OS: HR=0.31, (0.10, 0.96), p =0.04; DFS: HR=0.71, (0.41, 1.21), P=0.21) and advanced staged esophageal cancer patients (OS: HR=0.47, (0.33, 0.66), p <0.001; DFS: HR=0.62, (0.38, 0.99), P=0.05) were observed in the EBE surgery group, while TME showed less blood loss (MD=-74.03, (-96.69, -51.38), p <0.001), shorter operation time (MD=-32.37, (-65.12, 0.37), p =0.05) and better overall survival (HR=0.74, (0.55, 0.98), p for TME), studies in EBE subgroup unanimously indicated a longer operation time for EBE.","PeriodicalId":72157,"journal":{"name":"AME medical journal","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"AME medical journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.21037/amj-22-38","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Esophagectomy offers the chance of cure for esophageal cancer, however, the optimal circumferential extent of surgery remains uncertain. Yet, the practice of en bloc esophagectomy (EBE) and meso-esophagectomy (TME) reached inconsistent results, which led to the proposal of this study was to evaluate the surgical and oncological effect of EBE and TME on the esophageal cancer patients. Methods: Five databases were searched through March 1st, 2022, and the references of eligible studies were further searched in the databases and assessed. Randomized controlled trials (RCTs) comparing the e�cacy of EBE or TME were included. The outcomes were recorded in the forms of mean difference (MD), risk ratio (RR), odds ratio (OR) and hazard ratio (HR) with its corresponding 95% con�dence intervals (CI). Results: Overall, a total of 14 RCTs involving 3106 subjects were included. Compared with standard resection, a higher blood loss (MD=56.29, (14.80, 97.77), P=0.008), more lymph nodes acquired (MD=14.39, (9.79, 19.00), P<0.001) and better long-term outcomes for early (OS: HR=0.31, (0.10, 0.96), p =0.04; DFS: HR=0.71, (0.41, 1.21), P=0.21) and advanced staged esophageal cancer patients (OS: HR=0.47, (0.33, 0.66), p <0.001; DFS: HR=0.62, (0.38, 0.99), P=0.05) were observed in the EBE surgery group, while TME showed less blood loss (MD=-74.03, (-96.69, -51.38), p <0.001), shorter operation time (MD=-32.37, (-65.12, 0.37), p =0.05) and better overall survival (HR=0.74, (0.55, 0.98), p for TME), studies in EBE subgroup unanimously indicated a longer operation time for EBE.

查看原文本刊更多论文

食管整体切除术和食管全切除术对食管癌症患者的影响：系统回顾和荟萃分析

背景：食管切除术为癌症提供了治愈的机会，然而，手术的最佳圆周范围仍然不确定。然而，整体食管切除术（EBE）和食管中切除术（TME）的实践结果不一致，这导致本研究的建议是评估EBE和TME对食管癌症患者的手术和肿瘤学效果。方法：检索截至2022年3月1日的五个数据库，并在数据库中进一步检索和评估符合条件的研究的参考文献。随机对照试验比较�包括EBE或TME的cacy。结果以平均差（MD）、风险比（RR）、比值比（OR）和危险比（HR）的形式记录，其相应的95%为对照�置信区间（CI）。结果：总共纳入了14项随机对照试验，涉及3106名受试者。与标准切除术相比，早期出血量更高（MD=56.29，（14.80，97.77），P=0.008），获得的淋巴结更多（MD=14.39，（9.79，19.00），P<0.001），远期疗效更好（OS:HR=0.31，（0.10，0.96），P=0.04）；DFS：HR=0.71，（0.41，1.21），P=0.21）和晚期食管癌症患者（OS：HR=0.47，（0.33，0.66），P<0.001；DFS：在EBE手术组中观察到HR=0.62，（0.38，0.99），P=0.05），而TME表现出较少的失血（MD=-74.03，（-96.69，-51.38），P<0.001），更短的手术时间（MD=-32.37，（-65.12，0.37），P=0.05）和更好的总生存率（HR=0.74，（0.55，0.98），P对于TME），EBE亚组的研究一致表明EBE的手术时间更长。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

AME medical journal

CiteScore

2.60

自引率

0.00%

发文量