Minimally invasive resection for esophageal cancer.

MIE is technically demanding with a steep learning curve. Operative times decrease from 7 to 8 hours to 4.5 to 5 hours after the surgeons and assistants in the authors' center had performed 20 operations. In the authors' experience the operation was performed safely in the context of the authors' extensive experience with open esophageal surgery and advanced minimally invasive procedures. In the authors' first 77 cases, the 30-day operative mortality was zero, with a median hospital stay of 7 days, which compares favorably to many open series. Prospective studies will be required to determine whether postoperative pain, recovery time, and cost are improved. The optimal surgical approach for each patient should be decided based on surgical experience, tumor characteristics, and patient preference. A multi-institutional prospective trial is planned to evaluate the clinical and oncologic results of MIE for cancer compared with traditional open surgery.