Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature

Abstract

The impact of minimally invasive esophagectomy (MIE) on short term perioperative outcomes as opposed to open transhiatal esophagectomy (THE) and transthoracic esophagectomy (TTE) is still under debate. This systematic review attempts to answer whether minimally invasive surgery has improved short term outcomes compared to conventional open surgery in the management of esophageal cancer. A systematic literature search was performed using synonyms for esophagectomy, cancer and minimally invasive surgery. Ten case-controlled studies were retrieved and one systematic review. Data collection was grouped by surgical approach. Overall MIE data shows decreased blood loss (577 mL for conventional open surgery versus 312 mL for MIE) and reduction of hospital and ICU stay (open 19.6 days versus MIE 14.9 days, and open 7.6 days versus MIE 4.5 days respectively). Total complication rates are 60.4% for open esophagectomy and 43.8% for MIE. Pulmonary complications occur in 22.9% and 15.1% of respective procedures. Mean lymph node retrieval was higher in MIE (open 20.2 versus MIE 23.8). This review confirms the feasibility and safeness of minimally invasive surgery for esophageal cancer. Moreover, the retrieved studies collectively point towards improved short term outcomes after MIE. These results should be confirmed in randomized controlled trials.