Future Perspectives of Surgery for Esophageal Cancer

Esophageal cancer is one of the leading causes of cancer-related death worldwide. Surgery plays an important role in the treatment strategies for esophageal cancer. Recent advances in surgical techniques and perioperative management have dramatically improved the mortality rate; however, esophagectomy remains a highly invasive procedure that can lead to severe postoperative complications. Future advances in thoracoscopic surgery with the development of surgical endoscopy systems such as three-dimensional (3D) imaging systems with a 4K ultra high-definition camera or two-dimensional (2D) imaging systems with an 8K camera, which is expected to provide 3D-like visual sensation, will enable us to further understand the microscopic anatomy of the thoracic cavity and mediastinum, and to perform delicate surgical procedures that enable minimally invasive esophagectomy with mediastinal lymphadenectomy. A robot-assisted thoracoscopic esophagectomy is attractive for surgeons and may be beneficial to esophageal cancer patients. Preoperative simulation and intraoperative real-time navigation are expected to further help surgeons safely perform esophagectomy with lymphadenectomy. Reduction of the lymphadenectomy field and setting of lymphadenectomy areas with highest priority may be feasible when sentinel node (SN) navigation is appropriately performed in cN0 early-stage esophageal cancer. These technical advances are expected to decrease the morbidity and mortality rate of surgery for esophageal cancer and hopefully improve oncological outcomes.