A systematic review and meta-analysis comparing the safety and efficacy of open oesophagectomy and hybrid minimally invasive oesophagectomy.

Introduction: Surgical resection, with or without neoadjuvant therapy, remains the primary treatment for oesophageal cancer. The two main surgical approaches are open oesophagectomy (OE) and hybrid minimally invasive oesophagectomy (HMIE). However, their relative safety and efficacy remain controversial. This review aims to compare perioperative and postoperative complications between OE and HMIE in the management of oesophageal cancer.

Methods: Web of Science, EMBASE, PubMed, Scopus and the Cochrane Library were searched for relevant studies. Odds ratios (OR), standard mean differences (SMD) and 95% confidence intervals (CI) were used for statistical analysis.

Results: Eight studies involving 6,053 patients were included. HMIE was associated significantly with lower rates of conduit necrosis (risk ratio (RR)=3.54, 95% CI [1.07, 11.73]; p=0.04), postoperative pneumonia (RR=1.29, 95% CI [1.05, 1.57]; p=0.01) and recurrent laryngeal nerve paralysis (RR=2.51, 95% CI [1.13, 5.55]; p=0.02). No significant differences were observed in Clavien-Dindo complication grades IIIa-IVb (RR=1.13, 95% CI [0.92, 1.38]; p=0.24), grade V complications (RR=1.03, 95% CI [0.30, 3.51]; p=0.96), bleeding, inhospital mortality, 90-day mortality, duration of surgery, hospital stay or intensive care unit stay. Although not statistically significant, OE was associated with fewer cases of anastomotic and chyle leaks.

Conclusions: Both OE and HMIE have distinct advantages and drawbacks. HMIE appears superior in reducing conduit necrosis, postoperative pneumonia and nerve paralysis, whereas OE has slightly lower rates of anastomotic and chyle leaks. Surgical approach should be tailored to individual patient profiles. Further studies are needed to assess long-term oncologic outcomes.