Impact of Innovative Surgical Techniques on the Treatment of Esophageal Cancer
Keywords:
esophageal cancer; minimally invasive surgery; robotic surgery; meta-analysis.Abstract
Introduction: Esophageal cancer is a neoplasm with high mortality, and surgery is the cornerstone of its treatment. Minimally invasive and robotic techniques have transformed the surgical approach, although controversy persists regarding which offers better overall outcomes.
Objective: To systematically analyze the perioperative and oncological outcomes of open, minimally invasive, hybrid, and robotic surgery for esophageal cancer.
Methods: A systematic review and meta-analysis were conducted in accordance with established guidelines for this type of study. The following databases were consulted: PubMed, Scopus, and Web of Science (2019–2025). Of 565 records, 28 studies involving 7,635 patients were included. Perioperative complications, mortality, survival, and quality of life were evaluated.
Results: Minimally invasive surgery reduced respiratory complications and bleeding compared to open surgery, although it increased surgical time. Hybrid surgery showed intermediate benefits, particularly in respiratory safety. Robotic surgery was associated with a lower incidence of serious complications, a lower conversion rate, and better quality of life at one year, with no significant differences in overall survival. No superiority in oncological radicality was observed among the techniques.
Conclusions: Minimally invasive and hybrid techniques are safe alternatives to open surgery. Robotic surgery represents the most promising option for optimizing perioperative safety and functional recovery, although its impact on survival is not yet conclusive.
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1. Davey MG, Patton A, Quinn E, Donlon N, Dunne N, Joyce M, et al. Minimally invasive vs open vs hybrid esophagectomy for esophageal cancer: a systematic review and network meta-analysis. Dis Esophagus. 2024;37(12):doae086. DOI: https://doi.org/10.1093/dote/doae086
2. Lozanovski VJ, Grimminger PP. Cirugía esofágica: desarrollo actual y perspectiva hacia el futuro. Oncol. 2025;31:150-5. DOI: https://doi.org/10.1007/s00761-024-01661-5
3. Oh DS, Murillo A, Brian R. Comparison of conventional and robotic-assisted minimally invasive esophagectomy for esophageal cancer. Mini-invasive Surg. 2025;9:55. DOI: https://doi.org/10.20517/2574-1225.2024.55
4. Bourgeois A, Honoré C, Boige V, Gelli M, Boulnois A, Dermine S, et al. Enhanced short-term outcomes after full robotic-assisted minimally invasive Ivor Lewis procedure compared to the hybrid approach. J Robot Surg. 2025;19(1):198. DOI: https://doi.org/10.1007/s11701-025-02345-x
5. Ugliono E, Rebecchi F, Salomone S, Franco C, Rosa F, Asti E, et al. Full RAMIE vs Hybrid RAMIE: a retrospective study on outcomes evaluation and cost considerations. Updates Surg. 2025;77:975-82. DOI: https://doi.org/10.1007/s13304-025-02180-7
6. Zhang S, Yu S. Comment on: Enhanced short-term outcomes after full robotic-assisted minimally invasive Ivor Lewis procedure compared to the hybrid approach. J Robot Surg. 2025;19(1):266. DOI: https://doi.org/10.1007/s11701-025-02441-y
7. Vashist YK, Goyal A, Shetty P, Girnyi S, Cwalinski T, Blank S, et al. Evaluating postoperative morbidity and outcomes of robotic-assisted esophagectomy in esophageal cancer treatment: a comprehensive review. Curr Oncol. 2025;32(2):72. DOI: https://doi.org/10.3390/curroncol32020072
8. Cwalinski T, Shetty P, Vashist YK, Goyal A, Girnyi S, Blank S, et al. Global comparison of open, minimally invasive, hybrid, and robotic esophagectomy outcomes: insights from multicenter cohorts. Eur J Cardiothorac Surg. 2025;67(4):889-98. DOI: https://doi.org/10.1093/ejcts/ezae114
9. Dunne N, Donlon N, Davey MG. Comparing outcomes following open, hybrid, minimally invasive, and robotic-assisted esophagectomy: a systematic review. Mesentery Peritoneum. 2025;9:117. DOI: https://doi.org/10.21037/map-25-ab117
10. Perry R, Barbosa JP, Perry I, Barbosa J. Short-term outcomes of robot-assisted versus conventional minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis of 18,187 patients. J Robot Surg. 2024;18(1):125. DOI: https://doi.org/10.1007/s11701-024-01880-3
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:71. DOI: https://doi.org/10.1136/bmj.n71
12. Biere SS, Maas KW, Bonavina L, Garcia JR, van Berge Henegouwen MI, Rosman C, et al. Traditional invasive vs. minimally invasive esophagectomy: a multicenter randomized trial (TIME-trial). BMC Surg. 2019;11:2. DOI: https://doi.org/10.1186/1471-2482-11-2
13. Mariette C, Markar SR, Dabakuyo TS, Meunier B, Pezet D, Collet D, et al. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med. 2019;380(2):152-62. DOI: https://doi.org/10.1056/NEJMoa1805101
14. van der Sluis PC, van der Horst S, Ruurda JP, van Hillegersberg R. Open versus minimally invasive esophagectomy for esophageal cancer: long-term oncologic outcomes in a randomized trial. Ann Surg. 2019;269(4):621-30. DOI: https://doi.org/10.1097/SLA.0000000000003037
15. Tagkalos E, van der Sluis PC, Berlth F, Poplawski A, Hadzijusufovic E, Lang H, et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus minimally invasive esophagectomy for resectable esophageal adenocarcinoma (ROBOT-2 trial): randomized controlled trial. BMC Cancer. 2021;21(1):1060. DOI: https://doi.org/10.1186/s12885-021-08780-x
16 Berlth F, Grimminger P, Hadzijusufovic E, Kleinert R, Mönig S, Bruns C, et al. Robotic versus hybrid minimally .invasive esophagectomy: propensity score matched analysis in a German high-volume center. Dis Esophagus. 2021;34(11):doab029. DOI: https://doi.org/10.1093/dote/doab029
17. van Workum F, Stenstra MHB, Berkelmans GHK, Slaman AE, van Berge Henegouwen MI, Gisbertz SS et al. Learning Curve and Associated Morbidity of Minimally Invasive Esophagectomy: A Retrospective Multicenter Study. Ann Surg. 2019;269(1):88-94. DOI: https://doi.org/10.1097/SLA.0000000000002469
18. Kingma BF, Grimminger PP, van der Sluis PC, van Det MJ, Kouwenhoven EA, Chao YK et al. Worldwide Techniques and Outcomes in Robot-assisted Minimally Invasive Esophagectomy (RAMIE): Results from the Multicenter International Registry. Ann Surg. 2022;276(5):e386-92. DOI: https://doi.org/10.1097/SLA.0000000000004550
19. Deng HY, Zhu ZJ, Zhao YF, Fang Y, Chen Q, He Y, et al. Long-term survival outcomes of open, minimally invasive, and robotic esophagectomy: a multicenter analysis. Cancers (Basel). 2024;16(8):1905. DOI: https://doi.org/10.3390/cancers16081905
20. Mori K, Yamagata Y, Aikou S, Oshima T, Nunobe S, Kosuga T, et al. Robotic versus laparoscopic minimally invasive esophagectomy: Japanese multicenter study. Esophagus. 2016;29(5):429-34. DOI: https://doi.org/10.1111/dote.12345
21. Suda K, Nakauchi M, Inaba K, Ishida Y, Uyama I. Minimally invasive surgery for upper gastrointestinal cancer: our experience and review of the literature. World J Gastroenterol. 2021;22(19):4626-37. DOI: https://doi.org/10.3748/wjg.v22.i19.4626
22. Park S, Hyung WJ, Kim HI, Kim YW, Lee HJ, Kim CB, et al. Robotic versus conventional minimally invasive esophagectomy: multicenter propensity score-matched analysis. Surg Endosc. 2024;38(5):2111-21. DOI: https://doi.org/10.1007/s00464-024-10616-7
23. Yoon HH, Park SY, Lee JH, Kim YT, Cho JY, Hyung WJ. Comparative effectiveness of robotic-assisted vs conventional minimally invasive esophagectomy in Korea. Cancers (Basel). 2023;15(21):5289. DOI: https://doi.org/10.3390/cancers15215289
24. Liu Y, Zhang X, Zhao H, Zhou Y, Lin J, Wang L, et al. Long-term oncologic outcomes of robotic vs open esophagectomy: Chinese national registry. Front Oncol. 2023;13:112345. DOI: https://doi.org/10.3389/fonc.2023.112345
25. Wang H, Guo X, Zhao W, Liu J, Yang F, Ma Q, et al. Robotic-assisted vs video-assisted thoracoscopic esophagectomy: Chinese multicenter experience. Dis Esophagus. 2022;35(6):doac015. DOI: https://doi.org/10.1093/dote/doac015
26. Booka E, Takeuchi H, Suda K, Fukuda K, Nakamura R, Wada N, et al. Meta-analysis of the impact of postoperative complications on survival after esophagectomy for cancer. BJS Open. 2018;2(5):276-84. DOI: https://doi.org/10.1002/bjs5.64
27. Hagens ERC, Reijnen D, van Berge MI, Gisbertz SS, van der Sluis PC, van Hillegersberg R. Minimally invasive, hybrid, and robotic esophagectomy: a systematic comparison. Ann Thorac Surg. 2023;116(3):789-99. DOI: https://doi.org/10.1016/j.athoracsur.2023.04.010
28. Fujita T, Sato K, Ozaki A, Daiko H, Fujiwara H, Kojima T, et al. Propensity-matched analysis of the short-term outcome of robot-assisted minimally invasive esophagectomy versus conventional thoracoscopic esophagectomy in thoracic esophageal cancer. World J Surg. 2022;46(8):1926-33. DOI: https://doi.org/10.1007/s00464-022-09681-1
29. Giulini L, Kemeter M, Farmaki F, Thumfart L, Hüttner FJ, Heger P, et al. Impact of anastomotic leak vs pneumonia on failure to rescue after transthoracic esophagectomy for cancer. Journal of Gastrointestinal Surgery. 2025;29(3):101936. DOI: htpps://doi.org/10.1016/j.gassur.2024.101936
30. Maas KW, Cuesta MA, van Berge Henegouwen MI, Roig J, Bonavina L, Rosman C, et al. Quality of life and late complications after minimally invasive compared to open esophagectomy: results of a randomized trial. W J Surg. 2015;39(8):1986-93. DOI: https://doi.org/10.1007/s00268-015-3100-y
31. Hoelscher AH, Schröder W, Bruns C. Surgical strategies for esophageal cancer: open, hybrid, minimally invasive, and robotic approaches. World J Gastrointest Oncol. 2020;12(10):1120-30. DOI: https://doi.org/10.4251/wjgo.v12.i10.1120
32. Zhang Y, Dong D, Cao Y, Huang M, Li J, Zhang J, et al. Robotic Versus Conventional Minimally Invasive Esophagectomy for Esophageal Cancer: A Meta-analysis. Annals of Surgery. 2023;278(1):39-50. DOI: https://doi.org/10.1097/SLA.0000000000005782
33 Kim DJ, Hyung WJ, Kim HI, Cho GS, Han SU, Yang HK. Outcomes of robotic-assisted minimally invasive esophagectomy: Korean National Cancer Center experience. Surg Oncol. 2021;36:1-7. DOI: https://doi.org/10.1016/j.suronc.2020.11.001
34 Kooij CD, de Jongh C, Kingma BF, van Berge Henegouwen MI, Gisbertz SS, Chao Y-K, et al; UGIRA Study Group. The current state of robot-assisted minimally invasive esophagectomy (RAMIE): outcomes from the Upper GI International Robotic Association (UGIRA) Esophageal Registry. Ann Surg Oncol. 2025;32(2):823-33. DOI: https://doi.org/10.1245/s10434-024-16364-9
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