单孔与多孔电视辅助胸腔镜手术治疗食管癌微创食管切除术：一项GRADE评估的系统评价与荟萃分析。
Uniportal versus Multiportal Video-Assisted Thoracoscopic Surgery for Minimally Invasive Esophagectomy in Esophageal Cancer: A GRADE-Assessed Systematic Review and Meta-Analysis.
文献信息
| PMID | 42878946 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Fahad Amin |
| 作者单位 | King Edward Medical University, Lahore, Pakistan. fahadamin2003kemu@gmail.com. |
| 期刊 | Journal of gastrointestinal cancer |
| SCI 分区 | Q3 |
| IF | 1.8 |
| 研究类型 | 综述 Meta · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
背景： 微创食管切除术已成为食管癌的首选手术方式，单孔电视辅助胸腔镜手术（uVATS）作为传统多孔VATS（mVATS）的潜在改良方案而出现。然而，比较性证据仍局限于小型单中心研究。本系统评价与荟萃分析旨在全面评估接受微创食管切除术患者中uVATS与mVATS的围手术期及安全性结局。
方法： 系统检索了PubMed/MEDLINE、Embase、Scopus、Cochrane Library、Web of Science、ClinicalTrials.gov和CNKI，检索时间自建库至2026年4月。直接比较成人微创食管切除术中uVATS与mVATS的研究符合纳入标准。二分类结局以比值比合并，连续型结局以均数差合并，采用REML随机效应模型。使用I²统计量评估异质性。采用GRADE框架评价证据确定性。
结果： 共纳入9项比较uVATS与mVATS的研究。uVATS与术后第1天疼痛显著降低相关（MD -2.10，95% CI -3.63至-0.57；I² = 99.3%），术后肺炎减少（OR 0.41，95% CI 0.22-0.76；I² = 43.5%），住院时间缩短（MD -2.13天，95% CI -3.64至-0.63；I² = 96.8%）。两种术式在吻合口漏（OR 1.13，95% CI 0.61-2.09）、总体并发症（OR 0.79，95% CI 0.47-1.32）、喉返神经损伤（OR 0.89，95% CI 0.43-1.85）、围手术期死亡率（OR 0.53，95% CI 0.16-1.81）、术中出血量或总手术时间方面均未观察到显著差异。
结论： uVATS食管切除术似乎是mVATS可行且安全的替代方案，在术后疼痛、肺部并发症和住院时间方面具有潜在优势，同时保持相当的围手术期安全性。证据基础仍受限于高异质性和观察性研究占主导。需要采用标准化方案并进行长期肿瘤学随访的多中心随机试验来巩固这些发现。
英文摘要
BACKGROUND: Minimally invasive esophagectomy has become the preferred surgical approach for esophageal cancer, with uniportal video-assisted thoracoscopic surgery (uVATS) emerging as a potential refinement over conventional multiportal VATS (mVATS). However, comparative evidence remains limited to small single-centre studies. This systematic review and meta-analysis aimed to comprehensively evaluate perioperative and safety outcomes of uVATS versus mVATS in patients undergoing minimally invasive esophagectomy.
METHODS: A systematic search was conducted across PubMed/MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, ClinicalTrials.gov, and CNKI from inception through April 2026. Studies directly comparing uVATS with mVATS in adults undergoing minimally invasive esophagectomy were eligible. Binary outcomes were pooled as odds ratios and continuous outcomes as mean differences under REML random-effects model. Heterogeneity was assessed using I² statistics. Certainty of evidence was evaluated using the GRADE framework.
RESULTS: Nine studies comparing uVATS and mVATS were included. uVATS was associated with significantly lower postoperative pain on day one (MD - 2.10, 95% CI - 3.63 to - 0.57; I² = 99.3%), reduced postoperative pneumonia (OR 0.41, 95% CI 0.22-0.76; I² = 43.5%), and shorter length of hospital stay (MD - 2.13 days, 95% CI - 3.64 to - 0.63; I² = 96.8%). No significant differences were observed between approaches for anastomotic leakage (OR 1.13, 95% CI 0.61-2.09), overall complications (OR 0.79, 95% CI 0.47-1.32), recurrent laryngeal nerve injury (OR 0.89, 95% CI 0.43-1.85), perioperative mortality (OR 0.53, 95% CI 0.16-1.81), intraoperative blood loss, or total operative time.
CONCLUSION: UVATS esophagectomy appears to be a feasible and safe alternative to mVATS, with potential advantages in postoperative pain, pulmonary morbidity, and hospital stay while maintaining comparable perioperative safety. The evidence base remains limited by high heterogeneity and predominance of observational studies. Multicenter randomized trials with standardized protocols and long-term oncologic follow-up are needed to consolidate these findings.