J.Jpn. Surg. Soc.. 121(4): 435-441, 2020

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Feature topic

MINIMALLY INVASIVE ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER

The introduction of minimally invasive esophagectomy (MIE) marked the beginning of a new era. Because MIE has the potential to lower morbidity and enable a quicker return to normal function, it has attracted attention as a less-invasive approach and many surgeons are interested in performing the procedure. Recent meta-analyses and randomized controlled trials comparing MIE with open transthoracic esophagectomy have shown that MIE is associated with less operative blood loss, better postoperative quality of life, and a reduction in postoperative respiratory complications. Furthermore, survival rates after MIE were comparable with those after open esophagectomy. Although MIE is now a common procedure for the treatment of esophageal cancer, it includes several different approaches: thoracoscopic; mediastinoscopic; and robotic. MIE initially used thoracoscopy and laparoscopy, but many centers have started using robotic surgical systems. The recent advances in robotic esophagectomy have been astonishing, and several reports demonstrated improvements in the procedure and clinical results. On the other hand, some investigators perform the mediastinoscopic approach exclusively. We describe the short- and long-term outcomes of thoracoscopic, robotic, and mediastinoscopic esophagectomy, which indicate the usefulness of MIE as a less-invasive surgical procedure for the treatment of thoracic esophageal cancer.

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