{"doi":"10.1016/j.ejso.2025.110529","title":"Approaches for esophagectomy for esophageal cancer: a Network Meta-Analysis","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.","journal":"European Journal of Surgical Oncology","year":2025,"id":536938,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.959,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1422762,"name":"Elisabeth Wadewitz","orcid":null,"position":1,"is_corresponding":false},{"id":1422263,"name":"Yoshiaki Sunami","orcid":"0000-0002-1235-7512","position":2,"is_corresponding":false},{"id":1422264,"name":"Juliane Friedrichs","orcid":"0000-0001-8653-3948","position":3,"is_corresponding":false},{"id":1385798,"name":"Maurizio Grilli","orcid":"0000-0001-7649-7242","position":4,"is_corresponding":false},{"id":1422265,"name":"Johannes A. Vey","orcid":"0000-0002-2610-9667","position":5,"is_corresponding":false},{"id":728689,"name":"Johannes Klose","orcid":"0000-0002-7289-2891","position":6,"is_corresponding":false},{"id":1422266,"name":"Onur Bayram","orcid":"0000-0003-3236-4696","position":7,"is_corresponding":false},{"id":1422763,"name":"Marie Merling","orcid":null,"position":8,"is_corresponding":false},{"id":21628,"name":"Jörg Kleeff","orcid":"0000-0003-3432-6669","position":9,"is_corresponding":false},{"id":1422267,"name":"Ulrich Ronellenfitsch","orcid":"0000-0003-1107-813X","position":10,"is_corresponding":false},{"id":1422262,"name":"Artur Rebelo","orcid":"0000-0002-5267-079X","position":0,"is_corresponding":true}],"reference_count":31,"raw_metadata":null,"created_at":"2026-07-19T02:52:09.056872Z","pmid":"41151180","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}