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Minimally invasive oesophagectomy versus open surgery: is there an advantage?

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Abstract

Background

Oesophageal resection is the main method of curative treatment for cancer of the oesophagus. Despite advances in surgical technology and postoperative care, the survival rate and prognosis of people undergoing oesophagectomy is still poor. The use of minimally invasive techniques in oesophageal surgery offers hope of reduced recovery time due to a reduction in surgical trauma. Although the first reports of thoracoscopy- and laparoscopy-assisted oesophagectomy emerged some 20 years ago, there is still no consensus that the outcomes are clearly superior to outcomes following conventional open surgery. Increasingly, some surgeons promote the use of minimally invasive techniques for oesophagectomy but questions remain over its safety and efficacy compared with open surgery.

Methods

We conducted a systematic review of the literature to compare minimally invasive techniques for oesophagectomy to open surgery. The outcomes of interest for efficacy and safety included mortality, operative complications, recurrence, and quality of life.

Results

There were 28 included comparative studies. No randomised controlled studies (RCTs) were available and therefore the data need to be interpreted with caution.

Conclusion

Recommendations for future research are discussed. We argue that it is difficult to conduct an RCT for this procedure due to ethical considerations and suggest ways that future nonrandomised studies could be improved.

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Acknowledgments

This work was prepared by the School of Health and Related Research, University of Sheffield, with support from members of the National Institute for Health and Clinical Excellence (NICE). The views expressed in this document are not necessarily those of NICE.

Disclosures

Lesley Uttley, Fiona Campbell., Michael Rhodes, Anna Cantrell, Heather Stegenga, and Myfanwy Lloyd-Jones have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK

    Lesley Uttley, Fiona Campbell, Anna Cantrell & Myfanwy Lloyd-Jones

  2. Norfolk and Norwich University Hospitals, NHS, Norwich, UK

    Michael Rhodes

  3. National Institute for Health and Clinical Excellence, London, UK

    Heather Stegenga

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  1. Lesley Uttley
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Correspondence to Lesley Uttley.

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Uttley, L., Campbell, F., Rhodes, M. et al. Minimally invasive oesophagectomy versus open surgery: is there an advantage?. Surg Endosc 27, 724–731 (2013). https://doi.org/10.1007/s00464-012-2546-3

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