Comparing Minimally-Invasive and Open Approaches to Siewert II/III Gastro-Esophageal Junction Adenocarcinoma-A Systematic Review and Network Meta-Analysis.

BACKGROUND: The prevalence of adenocarcinoma of the esophagogastric junction has increased, likely driven by lifestyle factors such as obesity, gastro-esophageal reflux disease, and smoking. However, the long-term outcomes of different curative surgical approaches have yet to be comprehensively evaluated. OBJECTIVES: To perform a systematic review and meta-analysis evaluating the surgical approaches to resection of Siewert II/III Adenocarcinoma of the Esophagogastric junction. SETTING: Integration of data from upper gastrointestinal surgical units across the world. METHODS: A systematic review was performed as per PRISMA guidelines. Statistical analysis was performed with MetaInsight. RESULTS: A total of 16 studies, comprising 4256 patients, were included in the meta-analysis. The findings suggest that robotic surgical approaches demonstrate equipoise to both laparoscopic and open techniques for resection, with comparable overall survival (OS) at both 3 and 5 years (3-year OS: OR 1.17, 95% CI [0.10-14.06]; 5-year OS: OR 0.66, 95% CI [0.39-1.12]). Additionally, a nonsignificant trend toward improved disease-free survival (DFS) was observed for robotic surgery at both 3 and 5 years (OR 1.17, 95% CI [0.10-14.06] for both time points). CONCLUSION: Laparoscopic approaches to surgical resection have proven to be as effective as open surgery for achieving R0 resection. Based on our meta-analysis results, we can conclude that robotic approaches to resection is equivalent to laparoscopic approaches. PROSPECTIVE REGISTER: International Prospective Register of Systematic Reviews (PROSPERO): CRD42024590940.