Open versus minimally invasive esophagectomy: what is the best approach? Frame the issue

Surgical resection continues to be the gold standard treatment approach for early invasive and locoregional esophageal cancer. Esophagectomy has historically had a reputation as a complex operation with high mortality and morbidity. Increasingly, results from high-volume specialized centers have demonstrated that mortality rates of below 4% should be expected and that patients can potentially demonstrate excellent levels of quality of life following surgical resection. Up until recently, virtually all surgical resections were done utilizing an open approach utilizing either a transthoracic or a transhiatal operation. Over the past several years, however, a variety of fully minimally invasive or hybrid procedures have been advocated with a view of improving mortality and morbidity outcomes. In the absence of either randomized or controlled prospective comparisons, this series of papers will review current perceptions of the advantages of both minimally invasive and open surgery for the treatment of esophageal cancer.