Substitute or coexistence? Mediastinoscopy-assisted versus thoracoscope-assisted esophagectomy in esophageal cancer - A metaanalysis of perioperative outcomes and long-term survival

Sep 21, 2026

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Systematic review and meta-analysis comparing mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) for esophageal cancer. PRISMA-guided searches in PubMed, Web of Science, Cochrane Library, Embase, and CNKI up to 1 March 2024 included studies reporting perioperative outcomes and long-term survival. Twenty-one studies were analyzed with RevMan 5.4 using fixed or random-effects models based on heterogeneity. MAE reduced operation time, blood loss, hospital stay and tube times, and lowered pulmonary complications, but increased recurrent laryngeal nerve injury and yielded fewer lymph nodes dissected, with no difference in long-term survival.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Background

Methods

Search strategy and study selection

Outcomes and statistical analysis

Results

Perioperative outcomes

Survival outcomes

Conclusions

Introduction

Epidemiology and need for effective treatment

Role of minimally invasive esophagectomy

’Systematic Review and/or Meta-analysis Substitute or coexistence? Mediastinoscopyassisted versus thoracoscope-assisted esophagectomy in esophageal cancer: a metaanalysis of perioperative outcomes and long-term survival Pinhao Fang, MDa , Jianfeng Zhou, MDa , Yixin Liu, MDa , Zhiwen Liang, MDa , Yushang Yang, MDa , Siyuan Luan, MDa , Xin Xiao, MDa , Xiaokun Li, MDa , Hanlu Zhang, MDa , Qixin Shang, MDa , Longqi Chen, MD, PhDa , Xiaoxi Zeng, MD, PhDb , Yong Yuan, MD, PhDa,* Background: Currently, mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) represent two prevalent forms of minimally invasive esophagectomy extensively employed in the management of esophageal cancer (EC) . The aim of this meta-analysis is to assess and compare these two surgical approaches concerning perioperative outcomes and long-term survival, offering valuable insights for reﬁning surgical strategies and enhancing patient outcomes in this ﬁeld. Methods: Adhering to PRISMA guidelines, the authors systematically searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI databases until 1 March 2024, for studies comparing MAE and TAE. Outcomes of interest included perioperative outcomes (intraoperative outcomes, postoperative recovery, postoperative complications) and survival rates. Statistical analyses were performed using RevMan 5 .4, with heterogeneity dictating the use of ﬁxed or random-effects models. Results: A total of 21 relevant studies were ﬁnally included. MAE was associated with signiﬁcantly shorter operation times [mean difference (MD) = − 59 .58 min, 95% CI: − 82 .90 to − 36 .26] and less intraoperative blood loss (MD = − 68 .34 ml, 95% CI: − 130.45 to − 6 .23) . However, MAE resulted in fewer lymph nodes being dissected (MD = − 3 .50, 95% CI: − 6 .23 to − 0 . 78) . Postoperative recovery was enhanced following MAE, as evidenced by reduced hospital stays and tube times. MAE signiﬁcantly reduced pulmonary complications [odds ratio (OR) = 0.59, 95% CI: 0 .44, 0 .81] but increased the incidence of recurrent laryngeal nerve injury (OR = 1.84, 95% CI: 1 .30, 2 .60) . No signiﬁcant differences were observed in anastomotic leakage, chylothorax, cardiac complications, wound infections, and gastric retention between MAE and TAE. The long-term survival outcomes showed no statistical difference [hazard ratio (HR) = 1.05, 95% CI: 0 . 71, 1 .54] . Conclusions: MAE offers advantages in reducing operation time, blood loss, and speciﬁc postoperative complications, particularly pulmonary complications, with a shorter recovery period compared to TAE. However, it poses a higher risk of recurrent laryngeal nerve injury and results in fewer lymph nodes being dissected. No difference in long-term survival was observed, indicating that both techniques have distinct beneﬁts and limitations. These ﬁndings underscore the need for personalized surgical approaches in EC treatment, considering individual patient characteristics and tumor speciﬁcs. Keywords: esophageal cancer, mediastinoscopy-assisted esophagectomy, meta-analysis, perioperative outcomes, survival, thoracoscope-assisted esophagectomy aDepartment of Thoracic Surgery, Med+X Center for Informatics, West China Hospital, Sichuan University and bWest China Biomedical Big Data Center, Med+XCenter for Informatics, West China Hospital, Sichuan University, Chengdu, China P.F., J.Z., Y.L., Z.L. contributed equally to this work. Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article. *Corresponding author. Address: No.37 Guoxue Alley, Wuhou District, Chengdu, Sichuan 610041, China. Tel.: + [861 898 060 6739. E-mail: yongyuan@scu.edu.cn](861 898 060 6739. E-mail: yongyuan@scu.edu.cn) (Y. Yuan). Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open access article distributed under the Creative Commons Attribution-ShareAlike License 4.0, which allows others t

FAQs

What question does this meta-analysis address about MAE vs TAE?

It evaluates whether mediastinoscopy-assisted esophagectomy (MAE) and thoracoscope-assisted esophagectomy (TAE) differ in perioperative outcomes and long-term survival for patients with esophageal cancer.

How were studies selected and what databases were searched?

The authors followed PRISMA and searched PubMed, Web of Science, Cochrane Library, Embase, and CNKI until 1 March 2024 for studies comparing MAE and TAE.

What perioperative and complication differences were found between MAE and TAE?

MAE was associated with shorter operation time and less intraoperative blood loss, improved postoperative recovery, and fewer pulmonary complications, but it increased recurrent laryngeal nerve injury and reduced the number of lymph nodes dissected.

Sep 21, 2026

Uploaded by Levi