The following is the summary of “Open versus hybrid versus totally minimally invasive Ivor Lewis esophagectomy: Systematic review and meta-analysis” published in the December 2022 issue of Thoracic and cardiovascular surgery by Harriott, et al.

Less invasive alternatives to open Ivor Lewis esophagectomy, such as hybrid and minimally invasive approaches, have recently emerged. The goal of this research was to evaluate the relative success of open (OE), hybrid (HE), and minimally invasive (MI) esophagectomy totally minimally invasive esophagectomy (TMIE). In order to compare the success rates of OE, HE, and TMIE with intrathoracic anastomosis, a comprehensive literature search was conducted. 

Anastomotic leak rate, general morbidity, and mortality at 30 days were the primary endpoints. To compare the relative efficacy of the various methods, a meta-analysis of proportions was conducted. About 8,081 patients (50.3%), who underwent OE, 1524 (9.5%), who underwent HE, and 6,448 (40.2%), who underwent TMIE, were included in the analysis from 130 studies. After OE, there was a significant reduction in the risk of anastomotic leak (OR, 0.71; 95% CI, 0.62-0.81; P<.0001). The 95% confidence interval (CI) for the overall rate of morbidity following OE was 45%, HE was 40% (95% CI, 25%-59%), and TMIE was 37% (95% CI, 32%-43%) Estimates of risk show that OE (OR, 2.22; 95% CI, 1.76-2.81; P<.0001) and HE (OR, 1.93; 95% CI, 1.32-2.81;P<.0001) are associated with higher rates of postoperative mortality than TMIE. After OE, HE, and TMIE.

Patients stayed in the hospital for a median of 14.1 (range, 8-28), 12.5 (range, 8-18), and 11.9 (range, 7-30) days, respectively (P=.003). Overall morbidity, postoperative mortality, and length of stay are all reduced with HE and TMIE as compared to OE. Compared to HE, TMIE is associated with lower mortality rates and shorter LOS. More work is needed to ensure the widespread adoption of TMIE without compromising safety.

Source: sciencedirect.com/science/article/abs/pii/S0022522322000319