Esophagectomy, without thoracotomy or transmediastinal endodissection for esophageal carcinoma?

Recent advances in technical instrumentation have made possible the transmediastinal endodissection of the esophagus. Compared to the standard esophagectomy without thoracotomy, the transmediastinal endodissection is claimed to improve visual control, and reduce the incidence of recurrent nerve palsy and of cardiopulmonary complications. In this paper we compare the outcome of 671 transthoracic esophagectomies and 140 esophagectomies without thoracotomy performed between 1980 and 1990, and report the preliminary experience with 21 video assisted esophageal dissections performed in the last 2 years. Although the transmediastinal endodissection is feasible and may show some advantages over the standard esophagectomy without thoracotomy, at present its indications should be restricted to carefully selected patients who do not require extensive mediastinal lymphadenectomy. Prospective randomized studies are needed to assess the real advantages and long-term results of this technique.