Thoracoscopic and laparoscopic esophagectomy

Minimally invasive esophagectomy (MIE) has become an established option in the approach to esophageal resection and reconstruction for cancer. Technical and oncological outcomes are similar to those of open surgery, with evidence for improved respiratory outcomes with the MIE approach. The resection may be performed as a total MIE or there may be a combination of open and minimally invasive approaches (hybrid). The approach is used for cancers of the esophagus and gastroesophageal junction (GEJ). In our unit, the decision with respect to approach relates to the site of the primary cancer. The three-field dissection is suitable for cancers restricted to the esophagus. The two-field, Ivor Lewis, approach is used for cancers of the mid/lower and GEJ where there is gastric involvement that requires a proximal gastric resection that will not leave enough stomach for a neck anastomosis. The open approaches to the thoracic esophagus, including mobilization of the stomach to construct the gastric conduit, are described elsewhere (see Chapter 32, “Abdominal and right thoracic esophagectomy” and Chapter 33, “Left thoracic subtotal esophagectomy”)