Pushing the envelope of minimally invasive esophagectomy

Abstract

Esophageal cancer surgery-which is traditionally performed through laparotomy and thoracotomycarries significant risks in terms of morbidity and mortality (1). Over the last two decades, minimally invasive esophagectomy (MIE) has emerged as a valuable approach that may help reduce surgical trauma-ultimately minimizing complications rates. In 2012, the seminal European multicenter TIME trial demonstrated that total MIE-consisting of thoracoscopy and laparoscopy-was characterized by significantly lower rates of respiratory complications (9% vs. 29%, respectively) and a shorter length of stay (11 vs. 14 days, respectively) compared with the traditional open approach (i.e., thoracotomy and laparotomy) (2,3). In 2018, similar results were reported in the ROBOT (Robot-assisted Thoracolaparoscopic Esophagectomy vs. Open Transthoracic Esophagectomy) trial (4). In this study, 55 patients were randomly assigned to an open three-field esophagectomy, whereas 54 patients were randomized to a robot-assisted threefield esophagectomy (with the thorax being approached robotically and the abdomen laparoscopically). The overall complication rate (59% vs. 80%, respectively), the median blood loss (400 vs. 568 mL, respectively), and the rate of pulmonary complications (60% vs. 80%, respectively) were all lower in the robot-assisted group. Although there were no significant intergroup differences in terms of overall and disease-free survival, pain was less severe and quality of life was higher in the robot-assisted group (4).