Can mediastinoscopic esophagectomy be a choice of curative surgery? From the viewpoint of the short term outcomes: a clinical practice review

: To minimize the postoperative pulmonary complications after esophagectomy, transhiatal esophagectomy has been a choice of surgical procedure but regarded as oncologically insufficient surgery for esophageal squamous cell carcinoma, because it omits the mediastinal lymph node dissection, especially in the upper mediastinum. In the past decade, non-transthoracic radical esophagectomy with the combination of transcervical and transhiatal video-assisted surgery have been increasingly reported. This procedure, referred as mediastinoscopic esophagectomy, enables the retrieval of the whole posterior mediastinal regional lymph nodes via cervical and abdominal small incisions. Mediastinoscopic esophagectomy would be advantageous in the prevention of postoperative pulmonary complications because it can be completed without any manipulations on the lungs or the chest wall. However, transcervical part of the mediastinoscopic esophagectomy allows limited assistance from a second surgeon owing to the small skin incision and the narrow operative field. In addition, surgeons have to overcome technical issues, such as unfamiliar surgical view and susceptibility to the recurrent nerve injury. Nowadays, studies on the safety and the feasibility of mediastinoscopic surgery have been accumulated reporting its surgical outcome. A review of literatures on short term outcome was conducted here to clarify the feasibility of mediastinoscopic esophagectomy as an oncologic surgery. Fourteen studies and four review articles hit the PubMed search. Tracheal injury was reported in three studies with a frequency of 3.3–6.3% and no other type of intraoperative adverse event was reported. In-hospital mortality was rarely reported. The reported frequency of the pulmonary complication was less than 10% in the majority of the studies. The mediastinoscopic radical esophagectomy has been demonstrated as safe and feasible. However, its superiority in the short term outcome remains unknown.