Recent advances in thoracoscopic esophagectomy for esophageal cancer

Abstract

Technical advances and developments in endoscopic equipment and thoracoscopic surgery have increased the popularity of minimally invasive esophagectomy (MIE). However, there is currently no established scientific evidence supporting the use of MIE as an alternative to open esophagectomy (OE). To date, a number of single‐institution studies and several meta‐analyses have demonstrated acceptable short‐term outcomes of thoracoscopic esophagectomy for esophageal cancer, and we recently reported one of the largest propensity score‐matched comparison studies between MIE and OE for esophageal cancer, based on a nationwide Japanese database. We found that, in general, MIE had a longer operative time and less blood loss than OE. Moreover, compared to OE, MIE was associated with a lower rate of pulmonary complications such as pneumonia, and both methods had similar mortality rates. Although MIE may reduce the occurrence of postoperative respiratory complications, MIE and OE seem to have comparable short‐term outcomes. However, the oncological benefit to patients undergoing MIE remains to be scientifically proven, as no randomized controlled trials have been conducted to verify each method's impact on the long‐term survival of cancer patients. An ongoing randomized phase III study (JCOG1409) is expected to determine the impact of each method with regard to short‐ and long‐term outcomes.

Robot-assisted esophagectomy (RAE) versus conventional minimally invasive esophagectomy (MIE) for resectable esophageal squamous cell carcinoma: protocol for a multicenter prospective randomized controlled trial (RAMIE trial, robot-assisted minimally invasive Esophagectomy)

“…However, several problems still have not been solved. First, short-term outcomes were not obviously improved in esophageal cancer patients undergoing MIE [10]. Second, the oncological results of MIE remain to be proven, as no RCTs have demonstrated the long-term survival between MIE and OTE [11].…”

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

“…High complication rates, longer recovery times, and the desire for a less invasive procedure is what led to the innovation driving minimally invasive surgery. Specifically for esophagectomy, the definition of a MIE includes varying thoracoscopic and laparoscopic approaches for esophageal resection based on the location of the tumor, clinical stage, and patient characteristics [20,21] . In 1991, Dallemagne et al [22] first reported the use of laparoscopy for a hiatal hernia repair, inspiring Cuschieri et al [23,24] who utilized thoracoscopy for esophagectomy in 1992.…”

Comparison of laparoscopic surgery and hand‐assisted laparoscopic surgery in esophagectomy: A propensity score‐matched analysis

“…There are two different approaches to abdominal laparoscopy: hand‐assisted laparoscopic surgery (HALS), which provides the advantage of gentle gastric mobilization, and laparoscopic surgery (LAP), which allows easy lymph node dissection around the celiac artery. Although the efficacy of thoracoscopic esophagectomy has recently been clarified, the usefulness of laparoscopy has yet to be investigated 3,4 . Moreover, the differences in postoperative morbidity, mortality, and survival between HALS and LAP remain unclear.…”

“…Although the efficacy of thoracoscopic esophagectomy has recently been clarified, the usefulness of laparoscopy has yet to be investigated. 3,4 Moreover, the differences in postoperative morbidity, mortality, and survival between HALS and LAP remain unclear. Therefore, we aimed to examine and compare the safety and feasibility of HALS and LAP in esophagectomy in patients with esophageal cancer.…”