P-OGC28 Totally minimally invasive Oesophagectomies(Robotic & laparoscopic) are associated with an improved immediate post operative outcomes in comparison with open oesophagectomies;an upshot of a systematic review and metanalysis
Authors: Thulasiraman Sri vishnu , Virupaksha Suvi , Bhandari Mayank , Viswanath Yirupaiahgari Krishnaiah Setty 
Published: December 2021

Background

Radical oesophagectomy is the recognized standard curative surgery for operable oesophageal cancers. Postoperative morbidity and mortality are considerable following open oesophagectomy. Minimally invasive techniques- (thoraco-laparoscopy and robotic surgery) has evolved as an alternative for open techniques. Oncological outcomes, tumor clearance, lymph node yield, anastomotic leak, in-hospital and 30-day mortality are comparable between open and MIS techniques in various studies. Short term benefits like pulmonary complications, post-op quality of life, operative time, blood loss, pain control have not been studied widely. This meta-analysis aims at evaluation of  randomized trials that compare short term outcomes of totally minimally invasive versus open oesophagectomies

Methods

Three articles were selected after a systematic search of the literature. Methodological quality was assessed by Jadad scoring. Cochrane Risk of Bias (RoB) assessment tool was applied to determine the impact of bias. Pulmonary infections, Health-related quality of life EORTC C30 score, blood loss, operating time, 10-day pain score was recorded. CASP tool questionnaire was applied to individual studies by two authors separately. A random-effects model used to determine the overall effect. Weighted mean difference (WMD) or standardized mean difference (SMD) with 95%CI is calculated for continuous variable and Odds ratio for dichotomous variables. Heterogeneity between studies was measured using the Chi-square test and I2 test

Results

A total of 338 patients have been included. All baseline characteristics are matched to eliminate bias. Review results showed a statistically significant lower rate of pulmonary infections in MIS oesophagectomy with odds ratio 3.63 (2.09, 6.31; p-value&lt;0.00001). Postoperative QoL EORTC C30 was better in MIS group with SMD of 0.80 (0.57, 1.02; p-value&lt;0.00001). Operating time was significantly longer in the MIS technique, SMD of 1.50 (1.20, 1.80; p-value &lt;0.00001). The blood loss was significantly lower in the MIS group with SMD -1.74; p-value &lt;0.00001. MIS had significantly lower pain scores compared to open surgeries with SMD of -0.39 (-0.66,-0.13; p-value 0.004)

Conclusions

The meta-analysis showed a significant difference in postoperative pulmonary infections and health-related quality of life, favoring totally minimally invasive surgeries for oesophagectomies done for resectable oesophageal cancers. Other outcomes like pain control, blood loss was also better in minimally invasive groups. These benefits could outweigh the longer operating time in minimally invasive surgeries.  With time, after the steep learning curve is achieved, totally minimally invasive oesophagectomies will possibly be a better alternative to open surgeries in terms of short term postoperative outcomes