Open versus hybrid versus totally minimally invasive Ivor Lewis esophagectomy: Systematic review and meta-analysis

Neoadjuvant sintilimab and chemotherapy in patients with resectable esophageal squamous cell carcinoma: A prospective, single-arm, phase 2 trial

“…Surgery was scheduled for 21–42 days after the first day of the second treatment cycle. Patients completed radical surgery through the right chest and abdominal incision (Ivor-Lewis method) ( 25 ) and underwent two-field lymphadenectomy (the lymph nodes in the middle and lower mediastinum, upper abdomen, and the cervicothoracic junction of patients were selected for dissection). The following pathological evaluation after neoadjuvant therapy referred to the criterion of the College of American Pathologists (CAP)/National Comprehensive Cancer Network (NCCN) ( 26 ): All HE slides of patients enrolled in our trial were graded as 0 (PCR, no evidence of vital residual tumor cells), 1 (MPR, 10% or less vital residual tumor cells), 2 (residual cancer foci with interstitial fibrosis), and 3 (few or no tumor cell regression) under the microscope by pathologists.…”

Proton beam radiotherapy for esophageal cancer: challenges and opportunities in the modern era

“…Finally, the aforementioned topics regarding surgeon case volume notwithstanding, a putative factor potentially reducing the benefit of PBT is the use of minimally invasive esophagectomy. This was under‐represented in the aforementioned randomized trial, but is associated with fewer baseline POCs, postoperative hospitalization duration, and surgical mortality 9–10 . Although this procedure can be carried out with a variety of nuanced approaches/techniques (e.g., robotic vs. video‐assisted), it remains to be seen whether these next‐generation surgical approaches – especially at high‐volume centers – reduce POCs and surgical morbidities to an extent that the additional absolute risk reduction offered by PBT could be substantially less.…”

Prevention of Anastomotic Leak in Minimally Invasive Esophagectomy: The Role of Anastomotic Technique and Adjuvant Surgical Strategies

“…Management strategy for patients with esophageal cancer is multidisciplinary, depending on the neoplasia stage, and includes endoscopic procedures such as radiofrequency ablation, endoscopic mucosal resection, and endoscopic submucosal dissection and/or chemoradiotherapy (CRT) as an esophagus-preserving treatment for early esophageal cancer, while most cases are treated with surgical resection, combined with chemoradiotherapy [3]. The advent of minimally invasive esophageal surgery has led to lower rates of morbidity, mortality, shorter hospital stay, enhanced life quality, as well as better long-term oncological outcomes, compared with open esophagectomy [4,5].…”

“…Anastomosis construction is considered the most crucial step during esophagectomy. Despite the advantages offered by the adoption of minimally invasive Ivor-Lewis esophagectomy and the development of high-tech anastomotic staplers, anastomotic leakage (AL) remains a serious and possibly fatal complication after esophagectomy, with incidence higher than the open approach in numerous studies [4,8]. AL is defined as a "full-thickness gastrointestinal defect involving the esophagus, anastomosis, staple line, or conduit, irrespective of presentation or method of identification" by the Esophagectomy Complications Consensus Group and is classified into three types, depending on the management approach [9].…”

“…AL is the main cause of perioperative mortality, prolonged hospital stay, delayed oral feeding, need for reintervention, decreased overall survival, and increased risk of recurrence [10]. The steep learning curve of minimally invasive Ivor-Lewis esophagectomy is proposed as the main factor contributing to higher rates of AL, since AL incidence is limited to 4.5 % after the learning curve plateau had been achieved [4].…”