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

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.