Future directions—minimally invasive approaches to esophageal resection: a narrative review

Abstract

From the time of the first transthoracic esophagectomy to the present day, techniques for esophageal resection have evolved considerably. While open surgical techniques are still often employed, minimally invasive esophagectomy (MIE) has seen a tremendous rise in adoption in many centers worldwide and has in fact surpassed open esophagectomy. Robotic assisted minimally invasive esophagectomy (RAMIE) continues to increase steadily in recent years as well. Along with improved care algorithms including neoadjuvant and adjuvant treatments, minimally invasive approaches to esophageal resection have also contributed to a contemporaneous decrease in perioperative morbidity and mortality, as well as improvements in overall survival in esophageal cancer. Regardless of techniques or technologies employed, a continued reduction in complications such as anastomotic leak rate and pulmonary complications will be imperative in order to truly advance the field of esophageal resection. Importantly, endoscopic therapies such as endoscopic mucosal and submucosal resections (EMR/ESR) have garnered a substantial role in the treatment of early stage esophageal cancer. Novel robotic endoscopic platforms are in early development as well. The future of esophagectomy will no doubt continue to involve applications of new technology, including robotics and other novel developments.