Comparing Minimally-Invasive and Open Approaches to Siewert II/III Gastro-Esophageal Junction Adenocarcinoma-A Systematic Review and Network Meta-Analysis
In brief
Robotic and laparoscopic resections achieve similar 5-year survival to open surgery
In a meta-analysis of 16 studies involving 4,256 patients with Siewert II/III gastro-esophageal junction adenocarcinoma, robotic surgery showed overall survival at 3 and 5 years comparable to both laparoscopic and open approaches, with no clear advantage in disease-free survival. The findings suggest minimally-invasive techniques are oncologically equivalent to traditional open resection, though definitive superiority remains unproven.
- Journal
- World journal of surgery (Q1)
- Published
- 6 September 2026
- Study design
- Systematic review of cohort studies
- Evidence level
- Level 2, Moderate (CEBM 2a)
- Authors
- Connor J Colson, Matthew G Davey, Noel E Donlon
- PMID
- 42702841
- DOI
- 10.1002/wjs.70528
Why clinicians should know about it
- Picked for Surgical Oncology (paper of the day, 9 September 2026): Minimally‑invasive vs open Siewert II/III resection
Abstract
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.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.