Minimally invasive oesophageal resection for distal oesophageal cancer: A review of the literature

Abstract

Oesophagus resection is adequate treatment for some benign oesophageal diseases, especially caustic and peptic stenosis and end-stage motility dysfunction. However, the most frequent indications for oesophageal resection are the high-grade dysplasia of Barrett oesophagus and non-metastasized oesophageal cancer. Different procedures have been developed for performing oesophageal resection given the 5-year survival rate of only 18% among patients operated on. A disadvantage of the conventional approach is the high morbidity rate, especially with pulmonary complications. Minimally invasive oesophageal resections, which were first performed in 1991, may reduce this important morbidity and preserve the oncologic outcome. The first reports of morbidity and respiratory complications with this approach were disappointing and it seemed likely that the procedure would have to be abandoned. However, in the past 5 years, Japanese groups and the group of Luketich in Pittsburgh have given these techniques an important impetus. The outcomes of the new series are different from those in the beginning period, and are leading to an enormous expansion worldwide. Important factors behind the change are standardization of the operative technique, the experience of many surgeons with more advanced laparoscopic procedures, important improvements in instruments for dissection and division of tissues, a better technique in use of anaesthesia, and a better selection of patients for operation. Two minimally invasive techniques are being perfected: the three-stage operation by right thoracoscopy and laparoscopy, and the transhiatal laparoscopic approach. The former may be applied successfully for any tumour in the oesophagus, whereas the latter seems ideal for distal oesophageal and oesophagogastric junction tumours. This review article discusses all these aspects, giving special attention to indications and operative technique.

Techniques and short-term outcomes for total minimally invasive Ivor Lewis esophageal resection in distal esophageal and gastroesophageal junction cancers: pooled data from six European centers

“…Neoadjuvant treatment significantly increases 5-year survival of patients with esophageal cancer in both squamous cell and adenocarcinomas [6]. In addition, minimally invasive esophagectomy is increasingly being implemented in order to reduce postoperative respiratory complications and enhance the quality of life by avoiding a right thoracotomy and laparotomy [7–11]. …”

Mastering minimally invasive esophagectomy requires a mentor; experience of a personal mentorship

“…Using this approach, we served centers in the Netherlands [9], Sweden [1], Spain [5], Brazil [1], Switzerland [1], Greece [1] and India [2]. Of these, 12 centers had no previous MIE experience.…”

“…At the VU medical center, we started the MIE program in 1998 by using the laparoscopic transhiatal approach for distal and gastro-esophageal junction cancers (GEJ) [2], [3]. Aiming for better radicality with an adequate lymphadenectomy, we started with the thoracoscopic approach in lateral position in 2006 [4].…”

Minimally Invasive Subtotal Esophagectomy

“…Our own initial experience is promising and remains in accordance with modern trends and patient expectations. (13)(14)(15)(16).…”