Technique and role of minimally invasive esophagectomy for premalignant and malignant diseases of the esophagus.

Esophagectomy remains the standard of care in most centers for patients with resectable esophageal cancer. The choice of incision and conduit has remained the subject of much discussion. Open surgical approaches include the Ivor Lewis, transhiatal, left thoracoabdominal, three-hole, and left thoracoabdominal with left neck anastomosis. These techniques will be covered in the article by. Regardless of the approach, esophagectomy has been associated with considerable morbidity and mortality. Although modern anesthetic and surgical care has reduced the risks of esophagectomy, the incidence of major or minor complications is still approximately 70% to 80%, and the hospital mortality rate is 4% to 7% at experienced centers. In the hopes of reducing perioperative morbidity, minimally invasive techniques have been increasingly applied to esophageal surgery. Experience with laparoscopic antireflux surgery has allowed us to perform more and more complex surgery on the stomach and esophagus and, in 1995, surgeons began to report their experiences with minimally invasive esophagectomy using various techniques.