Minimally Invasive Esophagectomy for Esophageal Cancer: Current Evidence and Future Perspectives

Area of Science:

• Oncology
• Surgical Innovation
• Gastrointestinal Surgery

Background:

• Esophageal cancer is aggressive with regional variations in subtypes.
• Esophagectomy is the primary curative treatment, with minimally invasive esophagectomy (MIE) gaining traction to reduce invasiveness.
• Advancements in multimodal therapy complement surgical approaches.

Purpose of the Study:

• To review the current status and outcomes of minimally invasive esophagectomy (MIE) techniques.
• To compare different MIE approaches including thoracoscopic, robot-assisted, and mediastinoscopic methods.
• To outline the benefits and limitations of MIE in esophageal cancer treatment.

Main Methods:

• A comprehensive literature review of MIE studies was performed using PubMed/MEDLINE up to June 2025.
• The review focused on thoracoscopic, robot-assisted, and mediastinoscopic esophagectomy.
• Emphasis was placed on randomized trials and high-quality comparative studies.

Main Results:

• Thoracoscopic MIE, particularly in the prone position, shows reduced pulmonary complications and faster recovery than open surgery.
• Robot-assisted MIE (RAMIE) improves lymph node dissection and recurrent laryngeal nerve preservation.
• Mediastinoscopic esophagectomy is a viable option for high-risk patients, with reduced pulmonary complications but requiring further evaluation for lymph node dissection and nerve damage risks.

Conclusions:

• Minimally invasive esophagectomy (MIE) represents an evolving, less invasive alternative to open surgery for esophageal cancer.
• Standardized, multicenter trials are needed to optimize MIE strategies based on tumor and patient factors.