[Advancement of minimally invasive esophagectomy]

Esophageal cancer is one of the most common malignant digestive system cancers in China, which has high incidence and mortality. Nowadays, surgery remains the most important part of the comprehensive treatments. Conventional open esophagectomies are highly traumatic with high morbidity, while minimally invasive esophagectomy has been increasingly used with the development of surgical instruments and techniques in recent years. Compared with conventional open esophagectomy(OE), what are the advantages of minimally invasive esophagectomy (MIE) and which is preferable? This review briefly introduces the developing history of MIE and common procedures. Then we review large amounts of relevant literatures, comparing MIE with OE in perioperative rehabilitation, lymph node dissection and long-term survival. Results showed that compared with OE, MIE had less blood loss during operation, less postoperative pulmonary complications, shorter hospital stay and ICU time, meanwhile, there were no significant differences in the incidence of anastomotic leak, perioperative mortality, R0 resection and total number of resected lymph nodes. However, there are still no clear results of comparisons on operative time, recurrent laryngeal nerve palsy, and long-term survival, thus, more supportive evidences from prospective large-sample observation studies or randomized controlled trials are still needed. Furthermore, this review also presents the application and the progress of robotic-assisted MIE(RAMIE), demonstrates the current use of robotic technology during esophagectomies, meanwhile forecasts the future advancements of RAMIE. For the moment, the limitations of RAMIE to be widely used mainly include the cost and controlling of surgical indications, and we hope these can be settled in the coming years.