What question did this study set out to answer?

This review aims to compare the surgical and survival outcomes of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC).

February 20, 2026Open Access

Minimally invasive or open esophagectomy for esophageal squamous cell carcinoma: a comprehensive systematic review of surgical and survival outcomes

Key Points

This review aims to compare the surgical and survival outcomes of minimally invasive esophagectomy (MIE) and open esophagectomy (OE) in patients with esophageal squamous cell carcinoma (ESCC).
Conducted a PRISMA-compliant systematic review with pre-registered protocol.
Searched multiple databases for comparative studies published from January 2010 to May 2024.
Included nine studies involving 5,342 patients (2,968 MIE, 2,374 OE).
Assessed methodological quality using the Newcastle–Ottawa Scale.
Analyzed endpoints like overall survival, disease-free survival, and perioperative complications.
R0 resection rates were high (≥92%) for both MIE and OE, indicating oncologic equivalence.
55.6% of studies showed no significant differences in overall survival or disease-free survival between MIE and OE.
MIE showed advantages like reduced intraoperative blood loss and lower pulmonary complication rates, especially pneumonia.
Similar rates of anastomotic leaks and varying reports of recurrent laryngeal nerve injury were noted.

Abstract

Background Esophageal squamous cell carcinoma (ESCC) remains a common malignancy with high mortality. Minimally invasive esophagectomy (MIE) was developed to reduce the morbidity of conventional open esophagectomy (OE), but comparative evidence specifically addressing oncologic adequacy and postoperative recovery in ESCC is limited. This systematic review synthesizes comparative data on MIE vs. OE in ESCC. Methods We conducted a PRISMA-compliant systematic review registered on PROSPERO (CRD420251158559). PubMed/MEDLINE, Web of Science, and the Cochrane Library were searched for studies published between January 2010 and May 2024. Nine comparative studies ( n = 5,342; 2,968 MIE, 2,374 OE) met inclusion criteria. Methodological quality was assessed using the Newcastle–Ottawa Scale. Prespecified endpoints included overall survival (OS), disease-free survival (DFS), lymph node yield, R0 resection rate, perioperative complications, intraoperative blood loss, and lengths of ICU and hospital stay. Results Aggregate data indicate oncologic equivalence between MIE and OE: R0 resection rates were uniformly high (≥92%), and lymph node yields were comparable. Five out of nine studies (55.6%) reported no statistically significant differences in overall survival (OS) or disease-free survival (DFS) between MIE and OE. However, selected analyses favored MIE (e.g., 3-year OS HR 0.54, 95% CI 0.43–0.68). Perioperatively, MIE demonstrated consistent advantages, including reduced intraoperative blood loss, shorter hospital length of stay, and lower rates of pulmonary complications—particularly pneumonia—each of which was reported in seven of the nine included studies (77.8%). Anastomotic leak rates were similar; reports of recurrent laryngeal nerve injury were heterogeneous. Conclusion In ESCC, MIE achieves oncologic outcomes comparable to OE while conferring reduced pulmonary morbidity, lower blood loss, and accelerated postoperative recovery, supporting its consideration as a standard surgical approach. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251158559 , PROSPERO CRD420251158559.

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