الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
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SUMMARY
Esophageal cancer is the 6th most common malignancy
worldwide. Unfortunately, most patients still present with
locally advanced disease.
Surgical resection, when possible, remains the
cornerstone of therapy for esophageal cancer. It provides
complete excision of the primary tumor and associated regional
lymphatics.
Conventional esophagectomy is associated with
significant morbidity and mortality rates; however, reduction in
complication rates has been reported in centers with high
volume of esophageal surgery.
The use of thoracoscopy and/or laparoscopy for
esophageal resection was introduced in 1992 by Cushieri et al.,
hoping that it would further reduce pulmonary morbidity while
potentially improving the oncological quality of the resection
by enhancing visual control during the mediastinal dissection.
Many approaches were discussed in details in this review
including thoracoscopic and laparoscopic esophagectomy with
two field lymph node clearance and neck anastomosis
(Mckeown), laparoscopic and thoracoscopic esophagectomy
with two field lymph node clearance and intrathoracicanastomosis (Ivor-Lewis), transhiatal esophagectomy and
thoracoscopic esophagectomy in prone position
Experience in minimally invasive techniques for
esophageal cancer resection is widening. The potential
advantages of this approach relative to open esophagectomy
include smaller incisions, less intraoperative blood loss, a
reduction in some postoperative complications, decrease in
intensive care and overall hospital stay, and better preservation
of postoperative pulmonary function.
Areas of controversy include the optimal minimally
invasive technique (both transhiatal and transthoracic
approaches have been explored), the adequacy of the surgical
margins and lymph node dissection when a totally minimally
invasive approach is used, the safety of minimally invasive
esophagectomy in patients who have undergone preoperative
radiation therapy, and whether comparable long-term outcomes
can be achieved as compared to open esophagectomy
There are few reports that address oncologic outcomes in
patients undergoing totally minimally invasive esophagectomy,
and most are limited by small numbers and/or short follow-up
duration of less than two years.
Available studies show that the median number of lymph
nodes found in the MIE was significantly higher than LN
SUMMARY
138
retrieved during open esophagectomy and that is explained by
better visualization due to magnification. While there were no
differences in the rate of margin positivity.
Generally, there is a good short-term (30 day) survival
rate. Five-year survival was found to be not significant between
open and MIE. The studies available suggest that MIE may be
equivalent to standard open esophagectomy in achieving similar
oncological outcomes.
Open esophagectomy has a detrimental impact on healthrelated
quality of life (HRQL), with recovery taking up to a
year. Minimally invasive esophagectomy may enable a more
rapid recovery of HRQL.
Studies show that Six weeks after MIE, patients reported
deterioration in functional aspects of HRQL and more
symptoms than at baseline. However, most improved by 3
months and had returned to baseline levels by 6 months. These
levels were maintained 1 year after surgery, concluding that
MIE may lead to a rapid restoration of HRQL