Surgical treatment of esophageal cancer: benefit and limitation of endoscopic surgery

Since the 1990s, the minimalization of surgical invasiveness to reduce postoperative complications has become a major topic in the field of gastrointestinal surgery, including esophageal surgery. Initial challenges in the field of esophageal surgery were reported in 1993. Although the initial reports of thoracoscopic esophagectomy failed to show the lower incidence of postoperative complication compared with conventional open surgery, recent reports that cleared the initial learning phase are indicating relatively lower morbidity in endoscopic surgery. The magnified view by endoscope enables us to perform precise dissection of lymph nodes and to reduce total blood loss. Thus, endoscopic esophageal surgery has been introduced as a novel surgical approach for relatively early stage esophageal cancer. Although recent reports suggest several clinical benefits of this procedure compared with conventional open surgery, a large-scale randomized controlled trial to prove these potential benefits is essential.