Current advances and challenges in minimally invasive esophagectomy

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Thoracic Surgery

Background:

• Minimally invasive esophagectomy (MIE) adoption is increasing due to advances in endoscopic and thoracoscopic equipment.
• MIE offers advantages over open esophagectomy (OE), including reduced blood loss and fewer pulmonary complications, despite longer operative times.
• Patient positioning (left lateral decubitus vs. prone) and specific MIE techniques remain subjects of debate.

Purpose of the Study:

• To evaluate the efficacy and safety of minimally invasive esophagectomy (MIE) compared to open esophagectomy (OE).
• To assess the role of robotic-assisted and mediastinoscopic approaches in esophagectomy.
• To provide evidence supporting the adoption of MIE as a standard treatment modality.

Main Methods:

• Review of recent advancements in endoscopic and thoracoscopic surgical equipment.
• Analysis of patient positioning strategies for thoracoscopic esophagectomy (TE).
• Inclusion of data from a randomized phase III trial (JCOG1409) comparing TE and OE.

Main Results:

• Thoracoscopic esophagectomy (TE) is non-inferior to open esophagectomy (OE) in overall survival for thoracic esophageal cancer.
• MIE, including robotic and mediastinoscopic techniques, is associated with lower pulmonary complication rates.
• Comparable oncological outcomes are maintained with MIE compared to OE.

Conclusions:

• Minimally invasive esophagectomy (MIE) is a viable alternative to open esophagectomy (OE), with demonstrated benefits in reducing postoperative respiratory complications.
• The findings support the adoption of MIE as a standard treatment for esophageal cancer.
• Future research should focus on long-term outcomes and the optimal integration of robotic assistance in MIE.