Ösophaguschirurgie – aktuelle Entwicklung und Ausblick in die Zukunft

Esophageal cancer is one of the most aggressive malignant diseases, with a rising global incidence. Surgical resection as part of a multimodal approach remains the only curative treatment option. In recent decades, minimally invasive procedures such as hybrid minimally invasive esophagectomy (HMIE) and totally minimally invasive esophagectomy (MIE) have gained increasing importance. Studies such as ROMIO, ROBOT, and RAMIE demonstrate that these approaches can reduce postoperative complications, particularly pulmonary and cardiovascular issues, without compromising long-term oncological outcomes. Robot-assisted minimally invasive esophagectomy (RAMIE) represents an advancement, offering additional benefits through more precise dissection (precision surgery), reduced blood loss, and improved lymph node dissection. The ROBOT, RAMIE, and REVATE studies, along with other analyses, emphasize the significance of this procedure, especially for patients with squamous cell carcinoma. The ongoing ROBOT2 study aims to further strengthen the evidence base. Innovative technologies, such as the single-port da Vinci robotic system (Intuitive Surgical, Sunnyvale, CA, USA), offer new prospects with potentially less pain and faster recovery times, especially for patients with comorbidities who require a transcervical approach (SP-RACE; single-port da Vinci robot-assisted cervical esophagectomy), as it avoids opening the right-sided pleura and the need for one-lung ventilation. Future developments, such as the hinotori™ system (Medicaroid, Kobe, Japan), could further revolutionize surgical practice. However, despite these advancements, long-term data are still needed to comprehensively establish the oncological equivalence and benefits of new robotic approaches.