Minimally Invasive Surgery for Malignancies of the Gastrointestinal Tract: Esophagus - Contra Position

Background: The standard therapy for esophageal carcinoma traditionally is the open esophagectomy with lymphadenectomy. In the last few years, however, minimally invasive approaches were increasingly used. Methods: This review describes the contra position regarding minimally invasive approaches for esophageal carcinoma. We performed a literature search for current studies in PubMed. A total of one randomized controlled trial, four systematic reviews, and 18 retrospective cohort analyses were included. Results: The evidence level of the retrieved studies is low, while selection bias must be suspected for the retrospective cohort analyses. However, it seems to be clear that minimally invasive esophagectomy can be performed with at least similar morbidity and mortality as the open resection. Moreover, the minimally invasive approach coincides with less pain, shorter hospital duration, and early postoperative quality of life. There is controversy whether minimally invasive surgery reduces pulmonary complications since other factors apart from the operative approach, such as single-lung ventilation and patient positioning, also influence respiratory outcome. Conclusions: The current literature does not allow for an adequate evaluation of the oncologic outcomes of minimally invasive esophagectomy, despite comparable R0 resection rates and lymph node harvest. In the available studies, only little standardization of the applied operations as well as a great heterogeneity of the patient cohorts with respect to tumor type, stage, and follow-up are to be found.