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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2016; 8(1): 52-64
Published online Jan 27, 2016. doi: 10.4240/wjgs.v8.i1.52
Esophageal surgery in minimally invasive era
Lapo Bencini, Luca Moraldi, Ilenia Bartolini, Andrea Coratti
Lapo Bencini, Luca Moraldi, Ilenia Bartolini, Andrea Coratti, Division of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Azienda Ospedaliero-Universitaria di Careggi, 50134 Florence, Italy
Author contributions: All the authors contributed equally to this work; Bencini L conceived the idea and designed the research; Moraldi L, Bartolini I and Coratti A performed the research and contributed to the final draft of the paper.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lapo Bencini, MD, PhD, Division of Oncologic Surgery and Robotics, Department of Oncology, Careggi University Hospital, Azienda Ospedaliero-Universitaria di Careggi, Largo Brambilla 3, 50134 Florence, Italy. lapbenc@tin.it
Telephone: +39-55-7947404 Fax: +39-55-7947451
Received: April 24, 2015
Peer-review started: April 26, 2015
First decision: September 8, 2015
Revised: November 28, 2015
Accepted: December 4, 2015
Article in press: December 8, 2015
Published online: January 27, 2016
Abstract

The widespread popularity of new surgical technologies such as laparoscopy, thoracoscopy and robotics has led many surgeons to treat esophageal diseases with these methods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperative complications, length of hospital stay, and pain and better cosmetic results. All of these benefits could potentially be of great interest when dealing with the esophagus due to the potentially severe complications that can occur after conventional surgery. Moreover, robotic platforms are expected to reduce many of the difficulties encountered during advanced laparoscopic and thoracoscopic procedures such as anastomotic reconstructions, accurate lymphadenectomies, and vascular sutures. Almost all esophageal diseases are approachable in a minimally invasive way, including diverticula, gastro-esophageal reflux disease, achalasia, perforations and cancer. Nevertheless, while the limits of MIS for benign esophageal diseases are mainly technical issues and costs, oncologic outcomes remain the cornerstone of any procedure to cure malignancies, for which the long-term results are critical. Furthermore, many of the minimally invasive esophageal operations should be compared to pharmacologic interventions and advanced pure endoscopic procedures; such a comparison requires a difficult literature analysis and leads to some confounding results of clinical trials. This review aims to examine the evidence for the use of MIS in both malignancies and more common benign disease of the esophagus, with a particular emphasis on future developments and ongoing areas of research.

Keywords: Esophageal disease, Esophageal cancer, Laparoscopic, Robotic, da Vinci, Heller, Reflux disease, Esophageal diverticula

Core tip: Minimally invasive surgery for esophageal diseases is very attractive for reducing potentially serious complications that can occur after conventional surgery. However, if the oncologic long-term results remain the cornerstone of any procedure to treat malignancies, determining the outcomes of surgery for benign diseases requires a deep analysis of published evidence and a comparison with alternative pharmaceutical or endoscopic treatments.