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Page 6 of 8 Shibao et al. Mini-invasive Surg 2019;3:16 I http://dx.doi.org/10.20517/2574-1225.2019.01

However, since the current literatures are still limited, further large scale RCTs are needed. Thus, at present,
the surgical method should be decided is at the surgeon’s discretion.

ROBOTIC APPROACHES FOR EGJ CANCER
The introduction of surgical robots has shown the potential to expand the capabilities of performing complex
operations through improved visualization and maneuverability. Recently, many surgeons have found
robot-assisted thoracoscopic and transhiatal esophagectomy to be safe and acceptable for the treatment of
esophageal and gastric cancer . Future randomized trials are expected to establish this procedure as one
[43]
of the best approaches for esophageal and gastric cancer. Robotic surgery will be described in greater detail
in another chapter.

CONCLUSION
The incidence of cancer of EGJ has increased in worldwide. This article reviews MIE for cancer of EGJ. All
major approaches for the resection of EGJ cancer can be pursued by MIS. EGJ adenocarcinoma is traditionally
classified by the Siewert classification system, although which has some limitations. The definition and
classification of EGJ cancer remains controversial. MIE has emerged as a promising approach that might
reduce the postoperative complications in comparison to open techniques. The advantages of MIE as a
treatment for EGJ cancer in comparison to OE included a reduced hospitalization, and rate of pulmonary
complications, and an improved quality of life with a similar nodal harvest, margin status, and 1- and
3-year survival rates. However, since the current literature is still limited, the selection of surgical method
should be judged by the experienced surgeons. In any type of EGJ cancer, R0 radical resection is mandatory
for improving the patient’s prognosis. Minimally invasive Ivor-Lewis or McKeown esophagectomy are
the treatments of choice for Siewert type I cancer. Transhiatal esophagectomy is a surgical option for frail
patients, which is limited because the operator cannot perform mediastinal lymphadenectomy. Single-port
mediastinoscope-assisted transhiatal esophagectomy with mediastinal lymphadenectomy is an emerging
minimally invasive approach that also has curative potential. Laparoscopic total (or proximal) gastrectomy
is the optimal surgery for Siewert type III cancer, whereas both laparoscopic gastrectomy (with lower
esophagectomy) and a minimally invasive Ivor-Lewis approach are the optimal minimally invasive choices
for Siewert type II cancer. With the introduction of robotic surgery, esophagectomy is expected to evolve
even further.

In conclusion, since the current literature is still limited, further well-desined RCTs are needed to clarify the
optimal minimally invasive surgery for EGJ cancer.

DECLARATIONS
Authors’ contributions
Made substantial contributions to conception and design of the study and performed data analysis and
interpretation: Shibao K, Hirata K
Performed data acquisition, as well as provided administrative, technical, and material support: Mitsuyoshi
M, Matayoshi N, Inoue Y, Katsuki T, Sato N

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.