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Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes

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Abstract

Since the introduction of minimally invasive esophagectomy 25 years ago, its use has been reported in several high volume centers. With only one published randomized control trial and five meta-analyses comparing its outcomes to open esophagectomy, available level I evidence is very limited. Available technical approaches include total minimally invasive transthoracic (Ivor Lewis or McKeown) or transhiatal esophagectomy; several hybrid options are available with one portion of the procedure completed via an open approach. A review of available level I evidence with focus on total minimally invasive esophagectomy is presented. The old debate regarding the superiority of a transthoracic versus transhiatal approach to esophagectomy may have been settled by minimally invasive esophagectomy as only few centers are reporting on the latter being utilized. The studies with the highest level of evidence available currently show that minimally invasive techniques via a transthoracic approach are associated with less overall morbidity, fewer pulmonary complications, and shorter hospital stays than open esophagectomy. There appears to be no detrimental effect on oncologic outcomes and possibly an added benefit derived by improved lymph node retrieval. Quality of life improvements may also translate into improved survival, but no conclusive evidence exists to support this claim. Robotic and hybrid techniques have also been implemented, but there currently is no evidence showing that these are superior to other minimally invasive techniques.

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Authors and Affiliations

  1. Department of Surgery, Thomas Jefferson University Hospital, 1100 Walnut Street, Suite 500, Philadelphia, PA, 19107, USA

    Danica N. Giugliano, Adam C. Berger, Ernest L. Rosato & Francesco Palazzo

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  1. Danica N. Giugliano
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  2. Adam C. Berger
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  3. Ernest L. Rosato
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  4. Francesco Palazzo
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Correspondence to Francesco Palazzo.

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Danica N. Giugliano, MD, declares that she has no conflict of interest. Adam C. Berger, MD, declares that he has no conflict of interest. Ernest L. Rosato, MD, declares that he has no conflict of interest. Francesco Palazzo declares that he has no conflict of interest.

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Giugliano, D.N., Berger, A.C., Rosato, E.L. et al. Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes. Langenbecks Arch Surg 401, 747–756 (2016). https://doi.org/10.1007/s00423-016-1469-1

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