Efficacy of hybrid minimally invasive esophagectomy vs open esophagectomy for esophageal cancer: A meta-analysis

Table 1 Baseline characteristics of the eligible studies

Ref.	Time	Design	Area	Male/total		Age		Weight (kg/BMI)
				HMIE	OE	HMIE	OE	HMIE	OE
Yun et al[11]	2017	Retrospective	South Korea	51/53	61/62	66 48-83	68 45-79	NA	NA
Scarpa et al[14]	2015	Retrospective	Italy	25/34	27/34	62 52-70	64 56-70	NA	NA
Briez et al[13]	2012	Retrospective	France	110/140	117/140	NA	NA	NA	NA
Mariette et al[8]	2019	RCT	France	88/103	87/104	59 23-75	62 41-78	26 16-37	25 18-35
Glatz et al[15]	2017	Retrospective	Germany	49/60	52/60	61 42-92	61 44-84	27 19-40	26 17-38
Rinieri et al[17]	2016	Retrospective	France	59/70	54/70	61.1 ± 9	61 ± 9	NA	NA
Paireder et al[9]	2018	RCT	Austria	10/14	10/12	64.5 40-75	62.5 49-77	24.08 18.07-41.45	26.96 17.53-35.26
Rolff et al[22]	2017	Retrospective	Denmark	50/56	125/160	66 39-86	65 28-88	25.8 18.8-31.2	26.6 15.6-43.7
Parameswaran et al[10]	2013	Prospective	UnitedKingdom	23/31	15/19	67 48-79	64 51-77	NA	NA
Smithers et al[12]	2007	Prospective	Australia	247/309	104/114	64 27-85	62.5 29-81	80 41-132	78.5 40-119
Lee et al[16]	2011	Prospective	Taiwan	43/44	61/64	59.7 44-78	56.58 30-90	NA	NA
Findlay et al[19]	2016	Retrospective	United States	84/95	69/87	67.76	65.54	NA	NA
Safranek et al[20]	2010	Prospective	United Kingdom	28/34	38/46	63 44-76	60 44-77	NA	NA
Shiraishi et al[21]	2006	Retrospective	Japan	32/38	31/37	62.1 ± 9	66.5 ± 9.3	NA	NA
Kubo et al[23]	2014	Retrospective	Japan	34/42	60/74	65.4 ± 9	62.2 ± 7.2	NA	NA
Yanasoot et al[24]	2017	Retrospective	Thailand	13/16	46/54	58.19± 7.78	61.02± 8.59	NA	NA
Khan et al[18]	2017	Retrospective	Pakistan	17/31	52/90	48.7 ± 13.1	56.5 ± 10.7	22.3 15-30.8	21.6 15-35

NA: Not available; HMIE: Hybrid minimally invasive esophagectomy; OE: Open esophagectomy.

Table 2 Baseline characteristics

Ref.	Tumor location		Histological subtype		Pathological stage		ASA risk score
	Upper/Middle/ Lower		ACA/SCC		0-I-II/ III-IV		1/2/3
	HMIE	OE	HMIE	OE	HMIE	OE	HMIE	OE
Yun et al[11]	0/18/35	0/18/44	NA	NA	48/5	45/17	NA	NA
Scarpa et al[14]	0/25/9	0/29/5	24/10	24/10	29/5	29/5	5/22/7	4/17/13
Briez et al[13]	0/54/86	0/56/84	57/83	57/83	92/48	89/51	20/102/18	22/94/24
Mariette et al[8]	0/32/71	1/31/72	57/46	66/38	48/50	52/48	25/61/17	34/58/12
Glatz et al[15]	0/8/52	0/8/52	46/14	47/13	44/15	41/19	NA	NA
Rinieri et al[17]	60/10/0	63/7/0	50/20	55/15	52/18	49/21	9/48/13	14/40/16
Paireder et al[9]	NA	NA	10/4	11/1	7/7	8/4	NA	NA
Rolff et al[22]	NA	NA	NA	NA	NA	NA	17/28/12	41/80/39
Parameswaran et al[10]	NA	NA	27/3	16/3	18/31	8/11	NA	NA
Smithers et al[12]	8/68/208	0/3/47	199/74	100/7	183/108	36/75	12/200/98	6/68/38
Lee et al[16]	2/34/8	9/46/9	1/43	5/59	39/6	49/15	NA	NA
Findlay et al[19]	NA	NA	NA	NA	NA	NA	NA	NA
Safranek et al[20]	0/1/24	0/1/20	29/3	43/3	18/16	17/29	NA	NA
Shiraishi et al[21]	NA	NA	NA	NA	NA	NA	NA	NA
Kubo et al[23]	8/21/13	3/36/34	NA	NA	28/14	41/33	NA	NA
Yanasoot et al[24]	2/8/6	11/28/15	1/15	5/49	6/10	19/35	NA	A
Khan et al[18]	NA	NA	28/3	65/25	4/91	5/83	NA	NA

NA: Not available; ACA: Adenocarcinoma; SCC: Squamous cell carcinoma; ASA: American Society of Anesthesilogists; HMIE: Hybrid minimally invasive esophagectomy; OE: Open esophagectomy.

Table 3 Quality assessment of the eligible studies: Newcastle-Ottawa Scale for case control studies

Ref.	Selection				Comparability	Exposure			Total Score
	1	2	3	4	5	6	7	8
Parameswaran et al[10]	Y	Y	Y	Y	Y	Y	Y	Y	8
Yun et al[11]	Y	Y	Y	Y	Y	Y			6
Smithers et al[12]	Y	Y	Y	Y	Y	Y	Y		7
Briez et al[13]	Y	Y	Y	Y	Y	Y	Y		7
Scarpa et al[14]	Y	Y	Y	Y	Y	Y			6
Glatz et al[15]	Y	Y	Y	Y	Y	Y			6
Lee et al[16]	Y	Y	Y	Y	Y	Y	Y		7
Rinieri et al[17]	Y	Y	Y	Y	Y	Y	Y		7
Khan et al[18]	Y	Y	Y	Y	Y	Y			6
Findlay et al[19]	Y	Y	Y	Y	Y	Y	Y		7
Safranek et al[20]	Y	Y	Y	Y	Y	Y			6
Shiraishi et al[21]	Y	Y	Y	Y	Y	Y			6
Rolff et al[22]	Y	Y	Y	Y	Y	Y			6
Yanasoot et al[24]	Y	Y	Y	Y	Y	Y			6
Kubo et al[23]	Y	Y	Y	Y	Y	Y			6

1: Is the case definition adequate; 2: Representativeness of the cases; 3: Selection of controls; 4: Definition of controls; 5: Comparability of cases and controls on the basis of the design or analysis; 6: Assessment of exposure; 7: Same method of ascertainment for cases and controls; 8: Non-response rate; Y: Yes.

Table 4 Quality assessment of the eligible studies: Risk bias of Cochrane Collaboration tool for randomized controlled trials

Ref.	Random sequence generation	Allocation concealment	Blinding of participants and personnel	Blinding of outcome assessment	Incomplete outcome data	Selective reporting	Other bias
Paireder et al[9]	Low risk	High risk	Unclear risk	Unclear risk	Low risk	Low risk	Unclear risk
Mariette et al[8]	Low risk	Low risk	Low risk	High risk	Unclear risk	Unclear risk	Unclear risk

Table 5 Comparison of perioperative outcomes between hybrid minimally invasive esophagectomy and open esophagectomy groups

Perioperative outcomes	SMD and 95%CI		P value
Lymph node yield	Total HMIE vs OE	0.11 (-0.08, 0.30)	0.26
	HMIE with A vs OE	0.19 (-0.00, 0.37)	0.05
Blood loss	Total HMIE vs OE	-0.43 (-0.66, -0.20)	0.0002
	HMIE with A vs OE	-0.51 (-0.74, -0.27)	<0.0001
Operative time	Total HMIE vs OE	0.24 (-0.14, 0.61)	0.22
	HMIE with A vs OE	0.1 (-0.33, 0.52)	0.65

A: Laparoscopy and thoracotomy; SMD: Standard mean difference; CI: Confidence interval; HMIE; Hybrid minimally invasive esophagectomy; OE: Open esophagectomy.

Table 6 Postoperative outcomes between hybrid minimally invasive esophagectomy group and open esophagectomy groups

Postoperative outcomes	OR or SMD, 95%CI		P value
ICU stay	Total HMIE vs OE	-0.01 (-0.21, 0.19)	0.93
	HMIE with A vs OE	-0.05 (-0.37, 0.27)	0.76
Hospital stay	Total HMIE vs OE	-0.13 (-0.28, 0.01)	0.08
	HMIE with A vs OE	-0.37 (-0.64, -0.09)	0.009
Total complications	Total HMIE vs OE	0.68 (0.46, 0.99)	0.05
	HMIE with A vs OE	0.62 (0.41, 0.94)	0.02
Pulmonary complications	Total HMIE vs OE	0.72 (0.57, 0.90)	0.004
	HMIE with A vs OE	0.69 (0.53, 0.90)	0.005
Cardiac complications	Total HMIE vs OE	0.91 (0.62, 1.34)	0.64
	HMIE with A vs OE	0.97 (0.65, 1.43)	0.86
Anastomotic leak	Total HMIE vs OE	0.95 (0.67, 1.35)	0.78
	HMIE with A vs OE	0.99 (0.67, 1.46)	0.96
Total mortality	Total HMIE vs OE	0.7 (0.47, 1.06)	0.09
	HMIE with A vs OE	0.65 (0.4, 1.07)	0.09
30-d mortality	Total HMIE vs OE	1.00 (0.45, 2.23)	0.99
	HMIE with A vs OE	1.10 (0.47, 2.59)	0.82
90-d mortality	Total HMIE vs OE	0.80 (0.43, 1.48)	0.47
	HMIE with A vs OE	0.80 (0.43, 1.48)	0.47

A: Laparoscopy and thoracotomy; OR: Odds ratio; SMD: Standard mean difference; CI: Confidence interval; ICU: Intensive care unit; HMIE; Hybrid minimally invasive esophagectomy; OE: Open esophagectomy.