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WJOLS

10.5005/jp-journals-10007-1116
REVIEW ARTICLE Minimally Invasive Esophagectomy (MIE): Techniques and Outcomes
Minimally Invasive Esophagectomy (MIE):

Techniques and Outcomes

Sajesh Gopinath
Assistant Professor, Jubilee Medical College,Thrissur, Kerala, India

ABSTRACT

Background: Esophageal cancer is one of the major public health problems worldwide. Different methods of minimally invasive
esophagectomy (MIE) have been described, and they represent a safe alternative for the surgical management of esophageal cancer
in selected centres with high volume and expertise in them. The procedural goal is to decrease the high overall morbidity of a traditional
open esophageal resection.
Aims: This article reviews the most recent and largest series evaluation of MIE techniques.
Methods: A literature search performed using search engines Google, HighWire press, SpringerLink, and Yahoo. Selected papers are
screened for other related reports.
Results: Though MIE requires greater expertise and a long learning curve, once technique has been mastered it greatly reduces the
postoperative morbidity and mortality to a significant extent. There was not much difference in average operating time compared to open
surgery but bleeding was less in MIE. Mean hospital stay was similar to open surgery. There was no significant difference in number and
location of lymph nodes harvested.
Conclusion: The current review shows that MIE with its decreased blood loss, minimal cardiopulmonary complications and decreased
morbidity and oncological adequacy, represents a safe and effective alternative for the treatment of esophageal carcinoma.
Keywords: Esophagectomy, Minimally invasive, Laparoscopy, Thoracoscopy, Esophageal neoplasm.

INTRODUCTION Minimally invasive surgery has been done and found to be
possible in managing esophageal cancer, although
Esophageal cancer represents a major public health problem
worldwide. It is the eighth most common cancer in the apprehension was expressed about safety, efficacy,
world and sixth most frequent cause of death with an oncologic value or other advantages that justify longer
estimated 462,102 new cases and 385,877 deaths per year. 1 operations. This article discusses outcomes in the
According to SEER (Surveillance epidemiology and end management of esophageal cancer.
results) data, 5-year survival has improved modestly over The use of thoracoscopy and/or laparoscopy for
the past 30 years, from 6% in 1975 to 1977 to 17% in 1996 esophageal resection was introduced in 1992 by Cushieri
to 2002. 2 et al hoping that it would further reduce pulmonary
Since Czerny first successfully resected a cancer of the morbidity while potentially improving the oncological quality
cervical esophagus in 1877, esophagectomy has had a long of the resection by enhancing visual control during the
5
history of high morbidity and mortality followed by a mediastinal dissection. Laparoscopic transhiatal esophagec-
6
relatively poor long-term survival. Published perioperative tomy was first reported by De Paula et al in 1995 and by
9,10
7
mortality rates are available since 1940s, and the initial Swanstrom and Hansen in 1997. Luketich et al described
8
reported rate was 72%. By the 1970s, a review of all the combined thoracoscopic and laparoscopic approach for
8
published data showed a reduction in the rate to 29%. In esophagectomy.
8
1980s, it was 13%, and in 1990, it declined to 9%. Surgery
is the gold standard for treating localized esophageal cancer. AIMS
Poor long-term outcome and predominance of distant failure This article aims at discussing various techniques and
prompted the evaluation of the role of chemoradiotherapy. outcomes of minimally invasive esophagectomy.
No major difference was seen in survival between patients The following parameters were evaluated for laparos-
who underwent chemoradiotherapy followed by surgery copic and open procedure:
3,4
versus those who had surgery alone. Advances in surgical 1. Operating technique
technology, staging and perioperative care could further 2. Operating time
reduce surgical morbidity and mortality. Of these advances, 3. Intraoperative complications
minimally invasive esophagectomy (MIE) has the greatest 4. Risk of anesthesia
potential to improve on conventional esophageal surgery. 5. Rate of conversion to open surgery

World Journal of Laparoscopic Surgery, January-April 2011;4(1):53-58 53