Minimally invasive esophagectomy: clinical evidence and surgical techniques
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REVIEW ARTICLE
Minimally invasive esophagectomy: clinical evidence and surgical techniques C. Mann 1 & F. Berlth 1 & E. Hadzijusufovic 1 & H. Lang 1 & P. P. Grimminger 1 Received: 11 July 2020 / Accepted: 24 September 2020 # The Author(s) 2020
Abstract Background Surgical esophagectomy plays a crucial role in the curative and palliative treatment of esophageal cancer. Thereby, minimally invasive esophagectomy (MIE) is increasingly applied all over the world. Combining minimal invasiveness with improved possibilities for meticulous dissection, robot-assisted minimal invasive esophagectomy (RAMIE) has been implemented in many centers. Purpose This review focuses on the development of MIE as well as RAMIE and their value based on evidence in current literature. Conclusion Although MIE and RAMIE are highly complex procedures, they can be performed safely with improved postoperative outcome and equal oncological results compared with open esophagectomy (OE). RAMIE offers additional advantages regarding surgical dissection, lymphadenectomy, and extended indications for advanced tumors. Keywords Esophagectomy . Minimal invasive esophagectomy . Esophageal cancer . Robot-assisted minimal invasive esophagectomy
Introduction As 6th most fatal malignancy with approximately 500,000 new cases worldwide per year, esophageal cancer represents a serious oncological burden [1, 2]. Nowadays, multimodal therapeutic approaches—with surgery as cornerstone— achieve 5-year-survival rates up to 50% [3, 4]. Due to the high technical complexity of the totally minimally invasive esophagectomy (MIE), open esophagectomy or hybrid esophagectomy (laparoscopic and open thoracic) is still common practice for resectable esophageal cancer. Thereby, two factors appear extraordinarily challenging when performing an esophagectomy. Firstly, the esophagus and stomach are embedded in both the thorax and the abdomen. While performing an oncological esophagectomy, both abdominal and thoracic lymph node compartments must be dissected for a radical twofield lymphadenectomy. Therefore, a two-compartment
* P. P. Grimminger [email protected] 1
Klinik für Allgemein-, Viszeral und Transplantationschirurgie, Johannes Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
intervention is inevitable. Secondly, the thoracic esophagus is located right next to delicate and essential structures like the trachea and the bronchi, the cardiac atrium, and large vessels like the aorta, azygos vein, and pulmonary vein as well as crucial nerve structures. Hence, in regard to a recent international benchmark study, surgical esophagectomy—although performed in high-volume centers—is accompanied by an overall complication rate up to 60% [5]. The procedure needs to be performed in a way allowing most precise and exact preparation while keeping it as little invasive as possible to avoid complications, without compromising oncological principles. These requirements are leading towards minimally invasive surgery. This article reviews the origin and
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