Evaluation and patient selection for minimally invasive esophagectomy

Minimally invasive esophagectomy (MIE) is an evolving surgical alternative to traditional open esophagectomy. Despite considerable technical challenges, it was considered that MIE could be performed effectively by surgeons experienced in open esophageal resection and advanced laparoscopic surgery. This chapter illustrates the preoperative evaluation and operative indications of MIE for esophageal cancer. Firstly, a complete history and physical exam is required for counseling on preoperative optimization. Then, the operation can be conducted after standard preoperative work-up includes several parts, such as positron-emission tomography (PET), endoscopic ultrasound (EUS), esophagography and computed tomography (CT). To our knowledge, the operative indications for MIE is now extended due to the rapid development of surgical technique and detailed preoperative evaluation. Limited node invasion and neoadjuvant chemoradiation are not rigorous contraindications for MIE any more. Optimal results require elaborate evaluation, appropriate patient selection and a multidisciplinary team experienced in the management of esophageal cancer.