Variation in the Standard of Minimally Invasive Esophagectomy for Cancer—Systematic Review

• Published in: Seminars in thoracic and cardiovascular surgery 2012, Vol.24 (3), p.176-187
• Main Authors: Hanna, George B., MBChB, PhD, FRCS, Arya, Shobhit, BSc, MBBS, MRCS, Markar, Sheraz R., MRCS, MSc, MA
• Format: Article
• Language: English
• Subjects: Cardiothoracic Surgery; Consensus; Esophageal Neoplasms - mortality; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; esophagectomy; Esophagectomy - adverse effects; Esophagectomy - methods; Esophagectomy - mortality; Esophagectomy - standards; Guideline Adherence - standards; Humans; laparoscopic; Laparoscopy - adverse effects; Laparoscopy - mortality; Laparoscopy - standards; Lymph Node Excision - standards; minimally invasive esophagectomy; operating technique; Postoperative Complications - etiology; Practice Guidelines as Topic - standards; Practice Patterns, Physicians' - standards; Standard of Care - standards; Survival Analysis; Time Factors; Treatment Outcome
• ISSN: 1043-0679; 1532-9488
• DOI: 10.1053/j.semtcvs.2012.10.004

Minimally invasive esophagectomy (MIE) has been increasingly performed to treat esophageal cancer. Studies published between 1990 and 2012 that described the use of MIE for cancer in at least 50 patients were included for systematic review. The literature search retrieved 34 publications comprising 18 case series, 15 comparative studies, and 1 randomized control trial. Results revealed a wide variability in surgical techniques and perioperative outcomes with a lack of standardized definitions of postoperative complications. In most studies, radical formal lymphadenectomy was not performed and the lymph node harvest fell below the minimum number recommended to achieve survival benefits. There is a need to reach a consensus regarding surgical approaches in MIE, the definition of postoperative complications and the extent of lymphadenectomy before embarking on further randomized controlled trials comparing MIE vs. open approach.