A Systematic Review of Inflatable Transcervical Mediastinoscopic Oesophagectomy and McKeown Oesophagectomy in Oesophageal Cancer.

This study compared the clinical efficacy and practicality of inflatable transcervical mediastinoscopic oesophagectomy (TIME) versus minimally invasive 3-stage McKeown oesophagectomy (MIME) for oesophageal cancer. A comprehensive literature search from 2018 onwards was conducted in databases such as PubMed and Wiley Online Library, focusing on studies that detail these surgical methods. Primary outcomes assessed the feasibility and practicality of TIME and MIME, with secondary outcomes including post-surgical complications, using data from published sources. Results indicate that TIME is generally less invasive, associated with fewer pulmonary complications (6.43 vs. 15.42; p = 0.06, 95% CI: 3.71- 21.71) and shorter operative time (270.75 vs. 337.01 minutes; p = 0.60, 95% CI: 5,47- 8.61) compared to MIME, making it preferable for patients with previous thoracic surgeries or elderly patients. TIME also shows advantages in terms of shorter hospital stays (15.37 vs. 24.28 days; p = 0.21, 95% CI: 5.90- 23.74), less operative bleeding (138.94 vs. 187.53 ml; p = 0.28, 95% CI: 4.65-12.2), and fewer postoperative complications. However, concerns remain regarding the capability of TIME for lymph node dissection (15.47 vs. 29.42; p = 0.05, 95% CI: 4.74-32.65) and the resection of large tumours, such as T3 and T4 tumours, where MIME is perceived to perform better. The mortality rate was insignificant for both surgical methods (0.50 vs. 0.20; p = 0.22, 95% CI: 1.11-5.61), demonstrating their safety for patients with oesophageal cancer. Nonetheless, both techniques are deemed safe and effective for treating oesophageal cancer, with TIME demonstrating capability in resecting T3 tumours with good post-surgical outcomes. Key Words: Oesophageal cancer, Minimally invasive oesophagectomy, Thoracoscopy, Mediastinoscopy, McKeown oesophagectomy.