Minimally invasive esophagectomy: anastomotic techniques

Esophagectomy is one of the most technically challenging and potentially morbid procedures in thoracic surgery. Goals of esophagectomy include resection of the diseased esophagus with negative margins, an adequate lymphadenectomy, and restoration of gastrointestinal continuity. Traditionally, this required both a thoracotomy and laparotomy incision, which contributed significantly to the high rates of morbidity and mortality associated with this procedure. Esophageal surgery has since evolved considerably. Advances in minimally invasive techniques have improved surgical morbidity to the patient, while providing oncologic benefit that is equal or superior to open approaches. Despite these improvements, technical complications and their consequences persist. Anastomotic complications remain a significant cause of postoperative morbidity and mortality. Clinically, these complications are often devastating and can result in substantial reductions in postoperative quality of life and survival. For this reason, construction of the anastomosis is often considered the most critical step during an esophagectomy. Additionally, with the rise of minimally invasive esophagectomy, techniques for anastomotic construction have had to evolve in concert. As a result, the optimal technique and location for anastomotic creation is frequently debated. Despite extensive research debating the superior esophageal reconstruction method, there is no agreed upon operative standard. This review aims to highlight current methods and provide a critical review of current research.