Systematic review of robotic and non-robotic esophagectomy for the treatment in esophageal cancer patients: a meta-analysis

Objective: To conduct a meta-analysis to determine the relative merits between robotic-assisted minimally invasive esophagectomy (RAMIE) and conventional video-assisted minimally invasive esophagectomy (MIE) in esophageal cancer patinents. METHODS: Eligible studies or databases for articles were retrieved via systematical search to identify comparative studies reporting peri-operative outcomes for RAMIE and MIE. Pooled odds ratios (OR) and standardized mean difference (SMD) with 95% confidence interval (95% CI) were calculated using either a fixed-effects or a random-effects model. RESULTS: Thirty studies matched the selection criteria and were included for statistical analysis, which reported on 12578 subjects with 4176 in RAMIE and 8402 in MIE. Through outcomes comparison analysis between RAMIE and MIE, this meta-analysis indicated that RAMIE was associated with less estimated blood loss (EBL) (SMD = -19.25, 95% CI −34.52 to -3.99) and less pneumonia (OR = 0.81, 95% CI 0.66 to 1.00). Meanwhile, this meta-analysis indicated that MIE was associated with shorter operative time (SMD = 23.29, 95% CI 7.35 to 39.44), less recurrent laryngeal nerve paralyses (OR = 1.31, 95% CI 1.07 to 1.59) and less total complications (OR = 1.21, 95% CI 1.03 to 1.42). Furthermore, total length of stay (LOS) (SMD = -0.01, 95% CI -0.19 to 0.18) , total morbility (within 90 days after operation) (OR = 1.06, 95% CI 0.88 to 1.27) , number of resected nodes(SMD = 0.97, 95% CI -0.20 to 2.15), conversion(OR = 0.76, 95% CI 0.23 to 2.49) , anastomotic orifice fistulae(OR = 0.98, 95% CI 0.76 to 1.25), wound infection(OR = 0.83, 95% CI 0.44 to 1.56) and chylothorax(OR = 1.12, 95% CI 0.65 to 1.93) were not significantly different for both procedures. CONCLUSION: RAMIE for esophageal cancer is not superior to conventional video-assisted MIE in terms of results of related indicators. Further studies are required to confirm this result.