Radical minimally invasive esophagectomy for esophageal cancer via transcervical and transhiatal approaches: a narrative review

Wang, Zheng; Yang, Rongjie

doi:10.21037/jtd-21-1205

Cited by 2 publications

(1 citation statement)

References 11 publications

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“…Introduction of minimally invasive approach to esophageal surgery has increased the spectrum of patients able to undergo major resection. As proposed by Wang et al in 2021, MATHE can broaden the indications for esophagectomy, including patients with compromised pulmonary function, previous thoracic procedures, as well as patients with early-stage esophageal cancer (34).…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Transcervical Esophagectomy With Mediastinal Lymphadenectomy for Cancer. A Comparison With Standardized Techniques

Davakis¹,

Charalabopoulos²,

Kyros³

et al. 2022

Anticancer Res

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Pulmonary complications remain the most commonproblem following transthoracic esophagectomy. Minimally invasive approach has significantly improved clinical outcomes; however, respiratory distress is still significant. Minimally invasive transcervical esophagectomy with mediastinal lymphadenectomy avoids thoracic access, which may decrease pulmonary complications. Transcervical esophagectomy refers to transcervical esophageal mobilization and mediastinal lymphadenectomy followed by a transhiatal gastric and distalesophageal mobilization, abdominal and lower mediastinal lymphadenectomy. Adoption of innovative minimally invasive techniques for the transcervical or transhiatal approach, such as laparoscopy or robotic-assisted mediastinoscopy have made possible transmediastinal approach for radical esophagectomy. This novel approach with avoidance of thoracotomy or thoracoscopy can omit one lung ventilation as in transthoracic esophagectomy. Patients with previous thoracic surgery, impaired respiratory system, and major comorbidities, who are unable to undergo transthoracic esophagectomy, become candidates for radical esophagectomy with promising results. Minimally invasive transcervical esophagectomy for esophageal cancer is a safe and feasible approach and may be a valuable alternative with promising clinical and oncological outcomes.The mainstay of treatment for esophageal cancer is surgery. Esophageal surgery carries high rates of postoperative morbidity and mortality. For the treatment of distal esophageal and gastro-esophageal junction Siewert type I-II tumors, 2-stage or Ivor Lewis esophagectomy, with 2-field lymphadenectomy is considered the gold standard approach (1). On the other hand, for tumors of the mid or upper esophagus, 3-stage or McKeown esophagectomy with 2-field or 3-field lymphadenectomy can be performed (2).Two-stage transthoracic (TTE) esophagectomy consists of abdominal phase followed by a right thoracotomic phase, while 3-stage TTE constitutes of a right thoracotomic phase followed by abdominal and cervical phase. Transhiatal esophagectomy (THE), which does not include a thoracic phase was the treatment of choice more than twenty years ago; however, nowadays, its clinical implementation is limited due to lack of mediastinal lymphadenectomy and compromised oncological outcomes compared to Ivor Lewis or McKeown esohagectomy (3).Minimally invasive esophagectomy (MIE), executed as hybrid-MIE consisting either of laparoscopic phase and open 675 This article is freely accessible online.

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Section: Discussionmentioning

confidence: 99%