Robotic Esophagectomy for Esophageal Cancer

Esophageal cancer is the ninth most common cancer and the sixth leading cause of cancer-related death worldwide. For the ascending prevalence, both most common types of esophageal carcinoma, squamous cell carcinoma (SCC), and adenocarcinoma (AC) are responsible. Whereas SCC is still the most prevalent type of esophageal cancer worldwide, western countries face a decline in this type but a significant rise if adenocarcinoma including the adenocarcinoma of the esophagogastric junction (AEG). While surgery remains the cornerstone of therapy strategies with curative intent, multimodal treatments including chemotherapy or chemoradiation are able to achieve 5-year survival rates of more than 45%. As for successful oncological treatment options, the safety of the surgical procedure finds special attention. Esophageal resection still remains a very demanding operation with substantial surgical trauma and high morbidity. The use of minimally invasive techniques for esophageal resection is safe and oncologically justifiable. Present studies conclude that both fully minimally invasive—and robotic—assisted minimally invasive esophagectomy have yet further advantages in terms of postoperative morbidity. Anastomotic leakage rates differ between the studies but remain still higher than 10%. The severity of an anastomotic leakage has an impact in short and long-term survival. Up to date, there is no consensus for the optimal anastomotic technique. Higher lymph node yield is shown to have a positive relevance to overall survival. Latest multicenter cohort studies try to provide precise lymph node dissection maps according to the cancer type of the esophagus or the GEJ. The use of robotic assistance may lead to further surgical precision and facilitate such extended lymphadenectomies in the upper mediastinum. It is expected that the continuous technological development of robotic systems as well as promising robotic processes such as RACE (robotic assisted transcervical and transhiatal esophagectomy) could totally alter the today standards.