Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive?

Abstract

Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal cancer. However, it is one of the most invasive procedures with high morbidity. To reduce invasiveness, minimally invasive esophagectomy (MIE), which includes thoracoscopic, laparoscopic, mediastinoscopic, and robotic surgery, is becoming popular worldwide. Thoracoscopic esophagectomy in the prone position is ergonomic for the surgeon and has better perioperative arterial oxygen pressure/fraction of inspired oxygen (P/F) ratio. Thoracoscopic esophagectomy in the left decubitus position is easy to introduce because it is similar to standard right posterolateral open esophagectomy (OE) in position. It has a relatively short operative time. Laparoscopic approach could potentially have a substantial effect on pneumonia prevention under the condition of thoracotomy. Mediastinoscopic surgery has the potential to reduce pulmonary complications because it can avoid a transthoracic procedure. In robotic surgery, in the future, less recurrent laryngeal nerve palsy will be expected as a result of polyarticular fine maneuvering without human tremors. In studies comparing MIE with OE, mediastinoscopic surgery and robotic surgery are usually not included; these studies show that MIE has a longer operative time and less blood loss than OE. MIE is particularly beneficial in reducing postoperative respiratory complications such as atelectasis, despite no dramatic decrease in pneumonia. Reoperation might occur more frequently with MIE. There is no significant difference in mortality rate between MIE and OE. It is important to recognize that the advantages of MIE, particularly “less invasiveness”, can be of benefit at facilities with experienced medical personnel.

New Technique for Intrathoracic Implantation of Extraluminal Spiral Prostheses in the Trachea

“…For the evaluation of the blood vessels, the 2 methods had the same median value of 2 (absence of vascular involvement) and variance of 0.14 in mediastinoscopy, whereas by necropsy the variance was zero. This demonstrates the suitability of the technique and its low invasiveness and low possibility of traumatic injury to the adjacent structures of the trachea [8]. A recent study describes controlling hemostasis as the key to better visualization by the surgeon and reduction of the risk of iatrogenic nerve damage, especially the nerves in the area of the thorax entrance.…”

“…The esophagus is an important organ located near the trachea along its entire extension, and the injection of CO2 into the mediastinum makes the surgical field clearer, thus making the separation of esophagus easier and [8,18]. Hence, caution is necessary to avoid compromising this organ.…”

Targeted Molecular Therapies in the Treatment of Esophageal Adenocarcinoma, Are We There Yet?

“…The minimally invasive esophagectomy (MIE) has become an increasingly popular approach. Comparative results from multi-institutional randomized clinical trials are still needed, however meta-analysis of published data have been able to demonstrate oncologic equivalency between open and minimally invasive approaches [ 18 ]. MIE may offer some advantages including reduced in-hospital mortality, shorter hospital stays, enhanced postoperative recovery, and fewer pulmonary and cardiovascular complications [ 19 ].…”

Robotic esophagectomy: the evolution of open esophagectomy to current techniques and a review of the literature

“…Although the use of minimally invasive techniques has many advantages including lower respiratory complications and equivalent 30-day mortality [ Table 2] [32][33][34][35][36][37] , the use of thoracoscopic and laparoscopic surgery also has many drawbacks. First, visualization using both techniques is limited to two dimensions.…”