Transthoracic vs transhiatal surgery for cancer of the esophagogastric junction: A meta-analysis

Table 1 Basic characteristics of all of the pooled studies in the meta-analysis

Ref.	No. of patients		Age (mean ± SD or range)		Sex (M/F)		Siewert’s classification	Design	Country
	TT	TH	TT	TH	TT	TH
Gianotti et al[10]	33	58	61/11	66/13	21/12	38/20	II III	PS	Italy
Graham et al[11]	32	119	63/(22-86)	63/(22-86)	NR	NR	I II III	RS	England
Hulscher et al[12]	114	106	64/(35–78)	69/(23–79)	97/17	92/14	I II	RCT	Netherlands
Omloo et al[14]
Nakamura et al[13]	71	84	64/(28-90)	64/(28-90)	NR	NR	I II III	RS	Japan
Sasako et al[15]	85	82	63/(38–75)	60/(36–75)	63/22	71/11	II III	RCT	Japan
Wayman et al[16]	20	20	63/(59-70)	71/(43-78)	15/5	15/5	I II III	PS	England
Zheng et al[17]	284	47	60.7/0.57	56.4/1.6	204/80	31/16	II	RS	China

SD: Standard deviation; NR: Not reported; TT: Transthoracic group; TH: Transhiatal group; PS: Prospective study; RS: Retrospective study; RCT: Randomized controlled trial.

Table 2 Quality assessment of the randomized controlled trials in the meta-analysis

Ref.	Randomization	Blinding	Concealed allocation	Baseline features	Eligibility criteria	Loss tofollow-up	Selecting bias	Study quality
Hulscher et al[12]	Yes	No	Unclear	Yes	Yes	Yes	No	Fair
Omloo et al[14]	Yes	No	Unclear	Yes	Yes	Yes	No	Fair
Sasako et al[15]	Yes	No	Yes	Yes	Yes	Yes	No	Fair

Table 3 Overall survival details of the included studies

1Ref.	5-yr survival		Conclusions on overall survival
	TT	TH
Gianotti et al[10]	37%	42%1	Overall 1-yr survival and 3-yr survival rates are 82% and 54% in the TT group and 86% and 60% in the TH group, respectively. The TT approach results in a better postoperative outcome without compromising surgical radicality or patient survival
Graham et al[11]	20%	17%1	The 1-yr, 2-yr, 3-yr and 5-yr survivals are not affected by the use of preoperative radiotherapy or surgical approach. The TT and TH approaches are not associated with any difference in survival
Nakamura et al[13]	NR	NR	Overall survival of the TT group is significantly lower than that of the TH group. The TH group shows significantly better survival than TT for type II tumors, but not for type III tumors
Hulscher et al[12] Omloo et al[14]	36%	34%1	Overall 1-yr survival and 3-yr survival rates are 66% and 43% in the TT group and 73% and 41% in the TH group, respectively. There is no significant overall survival benefit for either approach. For type I tumors, the TT approach shows a potential survival benefit over the TH approach (51% vs 37%, P = 0.33)
Sasako et al[15]	37.9%	52.3%1	TH tends to achieve higher 5-yr survival rates for both type II and type III tumors compared with TT (52.2% vs 41.5% and 52.4% vs 34.9%). The trial was closed because TT does not improve survival after TH and led to increased morbidity
Zheng et al[17]	34.9%	40.19%1	Overall 1-yr survival and 3-yr survival rates are 71% and 43.2% in the TT group and 71.8% and 46.3% in the TH group, respectively. No significant difference is found between groups

¹No significance between TT and TH. TT: Transthoracic; TH: Transhiatal; NR: Not reported.