Open, hybrid or total minimally invasive esophagectomy; a comprehensive review based on a systematic literature search

Abstract

Abstract: Esophagectomy is the backbone of esophageal and gastroesophageal junction cancer with curative intention and the procedure is associated with significant risk for postoperative complications and mortality. Minimally invasive surgical techniques have been introduced with the aim to reduce morbidity and mortality. This review article has the objective to give an overview of the currently available evidence concerning the various techniques of minimally invasive esophagectomy (MIE) and their outcomes. A structured search of randomized controlled trials and large cohort studies published in the medical literature, comparing open and MIE techniques, was performed. Relevant studies were summarized, discussed and included in a comprehensive review based on the systematic literature search. MIE can be performed in various ways ranging from hybrid techniques to a totally minimally invasive approach. Increasingly also robotic surgical systems are being used. The published studies are somewhat ambiguous. Randomized trials report that MIE techniques are associated with a lower postoperative short-term morbidity and better short and medium term quality of life, compared to open esophagectomy (OE). Some population-based cohort studies suggest worse short-term outcomes after MIE. Most studies report long-term survival after MIE is at least similar to OE. The optimal surgical approach for esophageal cancer remains to be determined, but it is clear that MIE techniques will continue to develop and be an important part of treatment with curative intention in the future.