Related Experiment Video

Updated: Jan 13, 2026

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Low-Cost Single-Port LoCoSP Device for a Transcervical Approach in Minimally Invasive Transhiatal Esophagectomy

Published on: September 11, 2021

Approaches for esophagectomy for esophageal cancer: a Network Meta-Analysis

Artur Rebelo¹, Elisabeth Wadewitz¹, Yoshiaki Sunami¹

¹Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle (Saale), Halle (Saale), Germany.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

|October 28, 2025

Abstract

Introduction:

Esophageal cancer remains a leading cause of cancer-related mortality worldwide. Esophagectomy is the cornerstone of curative treatment, but the optimal surgical approach remains debated. Newer techniques such as hybrid esophagectomy, minimally invasive esophagectomy (MIE), and robot-assisted minimally invasive esophagectomy (RAMIE) have been developed to improve perioperative outcomes while maintaining oncologic efficacy. We aim to compare the effects of open, hybrid, minimally invasive, and robot-assisted approaches to esophagectomy on survival and perioperative outcomes in patients with esophageal cancer.

Methods:

A systematic review and network meta-analysis (NMA) were conducted, including 10 reports from 6 randomized controlled trials identified via PubMed, Cochrane Library, Embase, CINAHL, ClinicalTrials.gov, and ICTRP. Comparative analyses between open esophagectomy (OE), hybrid laparoscopy-thoracotomy (HYB LapS-ThoT), MIE, and RAMIE were performed using random-effects NMA models. Hazard ratios (HR), odds ratios (OR), and mean differences (MD) were calculated for outcomes.

Results:

There were no significant differences in overall survival among OE, HYB LapS-ThoT, MIE, and RAMIE. Pulmonary complications were significantly lower with MIE (OR 0.47, 95 % CI 0.33-0.69, p < 0.0001) and RAMIE (OR 0.39, 95 % CI 0.27-0.57, p < 0.0001) compared to OE. RAMIE yielded a higher lymph node harvest (MD 1.56, 95 % CI 0.58-2.54, p = 0.002) and lower reoperation rates (OR 0.65, 95 % CI 0.45-0.93, p = 0.020) than OE. HYB LapS-ThoT was associated with increased anastomotic leakage compared to OE (OR 1.66, 95 % CI 1.02-2.69, p = 0.041).

Conclusion:

MIE and RAMIE significantly reduce pulmonary complications without compromising survival. Hybrid approaches appear to increase the risk of anastomotic leakage. These findings support minimally invasive techniques, especially RAMIE; however, more evidence and further studies are needed to allow for a clearer and more definitive conclusion.

More Related Videos

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

Published on: April 17, 2020

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Single Incision Plus One Port Laparoscopic Proximal Gastrectomy with Double Channel Anastomosis for Gastric Cancer Treatment

Published on: December 27, 2024

Related Concept Videos

Esophageal Varices-II: Clinical Features and Management

Esophageal Varices-II: Clinical Features and Management

Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal Perforation-II: Clinical Manifestations and Management

Esophageal perforations manifest in various clinical forms, influenced by factors such as the perforation's cause and location (cervical, intrathoracic, or intra-abdominal), the extent of contamination, and potential injury to adjacent mediastinal structures. The timing between the perforation occurrence and treatment initiation also affects the clinical presentation.
Clinical Manifestations:

Esophageal Strictures-II: Clinical Features and Management

Esophageal Strictures-II: Clinical Features and Management

Patients with esophageal strictures often experience a range of symptoms. Initially, they may have difficulty swallowing solid foods, which can progress to include liquids. Additional symptoms may involve chest pain or discomfort, regurgitating food and fluids, heartburn, unintentional weight loss, coughing or choking during meals, and hoarseness.
Healthcare providers should gather a comprehensive medical history and conduct a physical examination for diagnosis. If esophageal stricture is...

Barrett Esophagus-II: Clinical Manifestations and Management

Barrett Esophagus-II: Clinical Manifestations and Management

Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...

Esophageal Varices-I: Introduction

Esophageal Varices-I: Introduction

Esophageal varices are dilated, tortuous veins which are found mainly in the submucosa of the lower esophagus but which may also appear higher up or extend into the stomach. They develop due to increased pressure in the portal venous system, often as a result of liver cirrhosis. This condition scars and damages the liver, impeding normal blood flow through the portal vein. To compensate, blood seeks alternative pathways, forming fragile new vessels (varices) in the esophagus and stomach. These...

Esophageal Strictures-I: Introduction

Esophageal Strictures-I: Introduction

Esophageal strictures involve abnormal narrowing or tightening of the esophagus. They vary in length and severity, ranging from mild constriction to complete obstruction, and are classified as benign (noncancerous) or malignant (cancerous).
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...

Articles linked to this work by shared authors, journal, and citation graph.

The insulin-like growth factor 2 mRNA-binding protein 2 affects tumor cell metabolism via mitochondrial transporter activity and lipid alterations.

Cell death discovery·2026

Gastric Scintigraphy as a Bridge Between Objective and Clinical Evaluation of Delayed Gastric Emptying Following Pancreatic Surgery-A Pilot Study.

Diseases (Basel, Switzerland)·2026

Beyond the bleed: bedside ultrasound reveals tension pneumoperitoneum in a patient with suspected acute variceal bleeding.

Zeitschrift fur Gastroenterologie·2026

Variable selection for clinical prediction models in low-dimensional data - a simulation study comparing traditional regression and machine learning methods.

BMC medical research methodology·2026

The Influence of Vitamin C on Stromal and Epithelial Cells of the Pancreas in Malignant and Benign/Inflammatory Pancreatic Diseases: Protocol for a Scoping Review.

JMIR research protocols·2026

Surgery in Oligometastatic Pancreatic Cancer: Narrative Systematic Review.

Cancers·2026

See all related articles