CONTEMPORARY MINIMALLY INVASIVE ESOPHAGECTOMY: COMPARATIVE ANALYSIS OF SURGICAL APPROACHES, TECHNIQUES AND CLINICAL OUTCOMES

Abstract

INTRODUCTION 
Esophageal cancer remains one of the leading causes of cancer-related mortality 
worldwide  despite  continuous  advances  in  diagnosis  and  multimodal  treatment. 
Surgical  resection continues  to represent  the  cornerstone  of curative  treatment  for 
patients  with  localized  and  locally  advanced  disease.  However,  conventional  open 
esophagectomy  is  associated  with  considerable  perioperative  morbidity  due  to  the 
complexity of the procedure and the need for extensive surgical exposure. 
The introduction of minimally invasive esophagectomy (MIE) has transformed the 
surgical  management  of  esophageal  cancer.  By  combining  laparoscopic, 
thoracoscopic, and, more recently, robot-assisted techniques, MIE aims to minimize 
surgical trauma while preserving oncological radicality. Several operative strategies 
have  evolved,  including  transhiatal  esophagectomy,  Ivor  Lewis  esophagectomy, 
McKeown esophagectomy, hybrid minimally invasive procedures, and robot-assisted 
minimally  invasive  esophagectomy  (RAMIE).  These  techniques  differ  in  the 
combination  of  cervical,  thoracic,  and  abdominal  surgical  access,  the  site  of 
anastomosis, the extent of lymphadenectomy, and perioperative outcomes. 
Over the past decade, numerous randomized controlled trials, systematic reviews, 
and  meta-analyses  have  compared  these  surgical  techniques.  Although  minimally 
invasive  approaches  consistently  demonstrate  lower  perioperative  morbidity  than 
conventional  open  surgery,  controversy  remains  regarding  the  optimal  operative 
strategy  for  different  clinical  scenarios.  The  selection  of  an  appropriate  technique 
depends on tumor location, oncological requirements, patient characteristics, and the 
experience of the surgical team.