Surgical outcomes after totally minimally invasive Ivor Lewis esophagectomy. A systematic review and meta-analysis
A partir d'une revue systématique de la littérature publiée entre 2000 et 2020 (38 études, 5 619 patients), cette méta-analyse évalue les résultats chirurgicaux (morbidité, mortalité, ...) après une oesophagectomie mini-invasive (intervention d'Ivor Lewis)
Background: A transthoracic esophagectomy is associated with high rates of morbidity. Minimally invasive esophagectomy has emerged to decrease such morbidity. The aim of this study was to accurately determine surgical outcomes after totally minimally invasive Ivor-Lewis Esophagectomy (TMIE). Methods: A systematic literature search was performed to identify original articles analyzing patients who underwent TMIE. Main outcomes included overall morbidity, major morbidity, pneumonia, arrhythmia, anastomotic leak, chyle leak, and mortality. A meta-analysis was conducted to estimate the overall weighted proportion and its 95% confidence interval (CI) for each analyzed outcome. Results: A total of 5619 patients were included for analysis; 4781 (85.1%) underwent a laparoscopic/thoracoscopic esophagectomy and 838 (14.9%) a robotic-assisted esophagectomy. Mean age of patients was 63.5 (55–67) years and 75.8% were male. Overall morbidity and major morbidity rates were 39% (95% CI, 33%–45%) and 20% (95% CI, 13%–28%), respectively. Postoperative pneumonia and arrhythmia rates were 10% (95% CI, 8%–13%) and 12% (95% CI, 8%–17%), respectively. Anastomotic leak rate across studies was 8% (95% CI, 6%–10%). Chyle leak rate was 3% (95% CI, 2%–5%). Mortality rate was 2% (95% CI, 2%–2%). Median ICU stay and length of hospital stay were 2 (1–4) and 11.2 (7–20) days, respectively. Conclusions: Totally minimally invasive Ivor-Lewis esophagectomy is a challenging procedure with high morbidity rates. Strategies to enhance postoperative outcomes after this operation are still needed.