Minimally invasive esophagectomy for esophageal carcinoma

Abstract

: The incidence of esophageal cancer has been increasing, and in the last year alone it is estimated that there upwards of 20,000 new diagnoses of esophageal cancer and approximately 15,000 deaths. Most patients in this age receive neoadjuvant chemoradiotherapy prior to surgical resection in an attempt to achieve a cure. The major open approaches are an Ivor Lewis (transthoracic), transhiatal, left thoracoabdominal approach, and “three-hole” McKeown esophagectomy. It is a surgical procedure with high reported rates of morbidity and mortality. Given high rates of morbidity and mortality, minimally invasive approaches to esophagectomy [minimally invasive esophagectomy (MIE)] has gained momentum as potential alternative in an attempt to minimize morbidity without sacrificing oncologic outcomes. Although complex and perhaps more time consuming, perioperative results are encouraging and generally trend toward fewer pulmonary complications, lower blood loss, shower ICU and hospitalization time. Further, it appears the technical skills can be obtained, and appear the learning curve appears to be approximately 40 patients. With these considerations in mind, it is likely the MIE will continue to grow in favorability for patients with surgically resectable esophageal cancer.