What is the best surgical approach for esophageal cancer?

TL;DR

This paper discusses the best surgical approaches for treating esophageal cancer, comparing traditional and minimally invasive techniques.

Contribution

The paper highlights the benefits and challenges of minimally invasive and robotic-assisted esophagectomy techniques.

Findings

Minimally invasive esophagectomy reduces postoperative pain and pulmonary infections.

Both MIE and RAMIE show similar oncological outcomes compared to open surgery.

Robotic-assisted approaches may offer additional benefits supported by future trials.

Abstract

Esophageal cancer is an aggressive tumor entity, and oncologic esophagectomy with two-field lymphadenectomy after perioperative chemotherapy or chemoradiotherapy is the standard of care for curative treatment. Oncological esophagectomy is a complex procedure associated with a relevant surgical trauma. Complications, such as severe pulmonary infections and anastomotic leakage with mediastinitis lead to a high morbidity rate. To reduce the surgical trauma, the minimally invasive technique was introduced in esophageal surgery. Minimally invasive esophagectomy is associated with less postoperative pain and a reduced rate of pulmonary infections. Currently, there are two major different totally minimally invasive techniques, the conventional laparoscopic/thoracoscopic approach (MIE) and the robotic assisted approach (RAMIE). Both methods require teaching due to the flat learning curve associated with these complex procedures. However, both MIE and RAMIE are performed safely in specialized centers. They are associated with improved short-term outcome and similar oncological outcome compared to open esophagectomy. The robotic assisted approach has additional benefits that may be supported by the results of more randomized controlled trials in the future.