Minimally invasive esophagectomy (MIE) was described in the 1990s in an effort to reduce operative morbidity because esophagectomy for benign or malignant disease is a complex operation with significant morbidity and mortality rates. Since then many institutions have adopted and described their series, but in 1998, Luketich et al. reported their initial experience with 8 patients who underwent MIE using either laparoscopic and/or thoracoscopic techniques.
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They showed that there were no perioperative mortalities, demonstrating the potential safety and feasibility of MIE. Almost a quarter of a century later, Luketich et al., one of the earlier pioneers of MIE, reported their extensive experience of 1033 consecutive patients undergoing MIE with acceptable lymph node resection, postoperative outcomes, and a 1.7% mortality rate.
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Similarly, we published a large series of 315 patients who underwent an MIE (McKeown approach) utilizing a cervical stapled side-to-side anastomosis with a mortality rate of 1%, a median length of hospital stay of 8 days, and an acceptable lymph node resection.
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More recently, a multicenter randomized trial evaluating MIE versus open esophagectomy illustrated a decrease in pulmonary infection in the first 2 weeks after surgery, highlighting the substantial early postoperative benefits of MIE.
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Despite improved results with neoadjuvant chemoradiation therapy, surgical resection remains as the only available curative option for patients with esophageal cancer. Consequently, MIE was developed to improve postoperative outcomes, making an effort to decrease invasiveness without compromising the extent of dissection and lymph node resection. In fact, many MIE studies have shown a decreasing trend in morbidity, length of stay, length of intensive care unit stay, and blood loss while still preserving the oncologic outcomes of open esophagectomy.2–4
Replicating these results requires expertise in advance laparoscopic and esophageal surgeries, remaining a volume-sensitive procedure with migration of patients toward high-volume centers with expert surgeons who perform these procedures on a routine basis. Hence, I congratulate the authors for their recent publication “Minimally invasive esophagectomy for adenocarcinomas of the gastroesophageal junction and distal esophagus: notes on technique,”
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and the adaptation of their MIE technique as part of their clinical practice and patient care.
