Abstract
Open surgical resection via transhiatal or transthoracic, including McKeown, access is the most viable option for curing esophageal cancer; however, the extensive nature of open surgery in both the chest and abdomen results in significant rates of morbidity and mortality. A natural response was the introduction of minimally invasive esophagectomy (MIE) and, later, endoscopic resection. In the hands of experienced surgeons, MIE can achieve equivalent or better perioperative mortality, morbidity, and oncologic outcomes as compared to open surgery. This review starts with an overview of open esophagectomy before delving into the evolving body of evidence on MIE outcomes and practices.
Similar content being viewed by others
References
Papers of particular interest, published recently, have been highlighted as: • Of importance
NIH – Surveillance Epidemiology and End Results. SEER stat fact sheets: esophagus. (Accessed July 2013). Available at: http://seer.cancer.gov/statfacts/html/esoph.html. Accessed 8/21/13.
Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med. 2003;349:2241–52.
Orringer MB, Marshall B, Chang AC, et al. Two thousand transhiatal esophagectomies: changing trends, lessons learned. Ann Surg. 2007;246(3):363–72.
Casson AG, Fernando HC. Thoracic approaches to esophagectomy. Mastery of cardiothoracic surgery (2nd Ed). Edited by Kaiser LR et al. 2007;c18:1–17 (e-copy).
Hulscher JB, van Sandick JW, de Boer AG, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med. 2002;347(21):1662–9.
Omloo JM, Lagarde SM, Hulscher JB, et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg. 2007;246(6):992–1000.
Boshier PR, Anderson O, Hanna GB. Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer: a meta-analysis. Ann Surg. 2011;254(6):894–906.
Rentz J, Bull D, Harpole D, et al. Transthoracic versus transhiatal esophagectomy: a prospective study of 945 patients. J Thorac Cardiovasc Surg. 2003;125(5):1114–20.
Atkins BZ, Shah AS, Hutcheson KA, et al. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg. 2004;78:1170–6.
Lagarde SM, Vrouenraets BC, Stassen LP, van Lanschot JJ. Evidence-based surgical treatment of esophageal cancer: overview of high-quality studies. Ann Thorac Surg. 2010;89(4):1319–26.
Cuschieri A, Shimi S, Banting S. Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb. 1992;37(1):7–11.
DePaula AL, Hashiba K, Ferreira EA, et al. Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc. 1995;5(1):1–5.
Luketich JD, Pennathur A, Awais O, et al. Outcomes after minimally invasive esophagectomy: review of over 1000 patients. Ann Surg. 2012;256(1):95–103. A landmark paper on MIE by the most experienced surgeon in the field.
Lazzarino AI, Nagpal K, Bottle A, et al. Open versus minimally invasive esophagectomy: trends of utilization and associated outcomes in England. Ann Surg. 2010;252(2):292–8.
Gemmill EH, McCulloch P. Systematic review of minimally invasive resection for gastro-oesophageal cancer. Br J Surg. 2007;94(12):1461–7.
Decker G, Coosemans W, De Leyn P, et al. Minimally invasive esophagectomy for cancer. Eur J Cardiothorac Surg. 2009;35(1):13–20. A critical review of outcomes from studies prior to 2009.
Uttley L, Campbell F, Rhodes M, et al. Minimally invasive oesophagectomy versus open surgery: is there an advantage? Surg Endosc. 2013;27(3):724–31.
Nafteux P, Moons J, Coosemans W, et al. Minimally invasive oesophagectomy: a valuable alternative to open oesophagectomy for the treatment of early oesophageal and gastro-oesophageal junction carcinoma. Eur J Cardiothorac Surg. 2011;40(6):1455–63. The most complete singe-institution study of minimally invasive versus open esophagectomy.
Ben-David K, Rossidis G, Zlotecki RA, et al. Minimally invasive esophagectomy is safe and effective following neoadjuvant chemoradiation therapy. Ann Surg Oncol. 2011;18(12):3324–9.
Hanna GB, Arya S, Markar SR. Variation in the standard of minimally invasive esophagectomy for cancer–systematic review. Semin Thorac Cardiovasc Surg. 2012;24(3):176–87.
Wright CD, Kucharczuk JC, O’Briend SM, et al. Predictors of major morbidity and mortality after esophagectomy for esophageal cancer: a Society of Thoracic Surgeons General Thoracic Surgery Database risk adjustment model. J Thorac Cardiovasc Surg. 2009;137(3):587–96.
Biere SS, van Berge Henegouwen MI, Maas KW, et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet. 2012;379(9829):1887–92. The first completed RCT on minimally invasive versus open esophagectomy.
Luketich JD, Alvelo-Rivera M, Buenaventura PO, et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg. 2003;238(4):486–94.
Parameswaran R, Titcomb DR, Blencowe NS, et al. Assessment and comparison of recovery after open and minimally invasive esophagectomy for cancer: an exploratory study in two centers. Ann Surg Oncol. 2013;20(6):1970–7.
Scarpa M, Valente S, Alfieri R, et al. Systematic review of health-related quality of life after esophagectomy for esophageal cancer. World J Gastroenterol. 2011;17(42):4660–74.
Peyre CG, Hagen JA, DeMeester SR, et al. The number of lymph nodes removed predicts survival in esophageal cancer: an international study on the impact of extent of surgical resection. Ann Surg. 2008;248(4):549–56.
Rizk NP, Ishwaran H, Rice TW, et al. Optimum lymphadenectomy for esophageal cancer. Ann Surg. 2010;251(1):46–50.
Veeramachaneni NK, Zoole JB, Decker PA, et al. Lymph node analysis in esophageal resection: American College of Surgeons Oncology Group Z0060 trial. Ann Thorac Surg. 2008;86(2):418–21.
Pennathur A, Awais O, Luketich JD. Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg. 2010;89(6):S2159–62.
Sarkaria IS, Rizk NP, Finley DJ, et al. Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: experience, technique and cautions during early procedure development. Eur J Cardiothorac Surg. 2013;43(5):e107–15.
Nagpal K, Ahmed K, Vats A, et al. Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc. 2010;24:1621–9.
Smithers BM, Gotley DC, Martin I, Thomas JM. Comparison of the outcomes between open and minimally invasive esophagectomy. Ann Surg. 2007;245(2):232–40.
Markar SR, Arya S, Karthikesalingam A, Hanna GB. Technical factors that affect anastomotic integrity following esophagectomy: systematic review and meta-analysis. Ann Surg Oncol. 2013 Aug 14.
Maas KW, Biere SS, Scheepers JJ, et al. Minimally invasive intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer: a review of transoral or transthoracic use of staplers. Surg Endosc. 2012;26(7):1795–802.
Dunn DH, Johnson EM, Morphew JA, et al. Robot-assisted transhiatal esophagectomy: a 3-year single-center experience. Dis Esophagus. 2013;26(2):159–66.
Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis. J Thorac Cardiovasc Surg. 2013;145(1):90–6.
Weksler B, Sharma P, Moudgill N, et al. Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy. Dis Esophagus. 2012;25(5):403–9.
Palanivelu C, Prakash A, Senthilkumar R, et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position–experience of 130 patients. J Am Coll Surg. 2006;203(1):7–16.
Jarral OA, Purkayastha S, Athanasiou T, Zacharakis E. Should thoracoscopic three-stage esophagectomy be performed in the prone or left lateral decubitus position? Interact Cardiovasc Thorac Surg. 2011;13(1):60–5.
Swisher SG, Deford L, Merriman KW, et al. Effect of operative volume on morbidity, mortality, and hospital use after esophagectomy for cancer. J Thorac Cardiovasc Surg. 2000;119(6):1126–32.
Enestvedt CK, Perry KA, Kim C, et al. Trends in the management of esophageal carcinoma based on provider volume: treatment practices of 618 esophageal surgeons. Dis Esophagus. 2010;23(2):136–44.
Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–37.
Markar SR, Karthikesalingam A, Thrumurthy S, Low DE. Volume-outcome relationship in surgery for esophageal malignancy: systematic review and meta-analysis 2000-2011. J Gastrointest Surg. 2012;16(5):1055–63.
Dimick JB, Goodney PP, Orringer MB, Birkmeyer JD. Specialty training and mortality after esophageal cancer resection. Ann Thorac Surg. 2005;80(1):282–6.
Jaffer A. Ajani (chair), et al. Esophageal and esophagogastric junction cancers. NCCN Clinical Practice Guidelines in Oncology v2.2013. (Accessed August 2013). Available: http://www.nccn.org/professionals/physician_gls/pdf/esophageal.pdf. Expert consensus and evidence-based guidelines for the evaluation and treatment of esophageal cancer.
Vieth M, Ell C, Gossner L, et al. Histological analysis of endoscopic resection specimens from 326 patients with Barrett’s esophagus and early neoplasia. Endoscopy. 2004;36(9):776–81.
Pennathur A, Farkas A, Krasinskas AM, et al. Esophagectomy for T1 esophageal cancer: outcomes in 100 patients and implications for endoscopic therapy. Ann Thorac Surg. 2009;87(4):1048–54.
Pech O, Behrens A, May A, et al. Long-term results and risk factor analysis for recurrence after curative endoscopic therapy in 349 patients with high-grade intraepithelial neoplasia and mucosal adenocarcinoma in Barrett’s oesophagus. Gut. 2008;57(9):1200–6.
Hunt BM, Louie BE, Dunst CM, et al. Esophagectomy for failed endoscopic therapy in patients with high-grade dysplasia or intramucosal carcinoma. Dis Esophagus. 2013 Jun 24 (abstract).
Compliance with Ethics Guidelines
Conflict of Interest
Mohan K. Mallipeddi and Mark W. Onaitis declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Author information
Authors and Affiliations
Corresponding author
Additional information
This article is part of the Topical Collection on Gastrointestinal Cancers
Rights and permissions
About this article
Cite this article
Mallipeddi, M.K., Onaitis, M.W. The Contemporary Role of Minimally Invasive Esophagectomy in Esophageal Cancer. Curr Oncol Rep 16, 374 (2014). https://doi.org/10.1007/s11912-013-0374-9
Published:
DOI: https://doi.org/10.1007/s11912-013-0374-9