Worldwide survey on the transcervical approach for minimally invasive treatment of esophageal cancer: results of questionnaire of the international collaborative group on transCervical Minimally Invasive Esophagectomy

Minimally invasive esophagectomy has emerged over open surgery, showing important advantages on the short time and comparable oncological outcomes, though concerns persist about pulmonary complications. The avoidance of the thoracic route has shown lower pulmonary complication rates compared to traditional approaches. Since 2015, a novel technique was introduced combining single port transcervical and transhiatal laparoscopic mediastinal dissection for esophageal resection. The procedure is nowadays expanding, following the IDEAL framework stage 2b an international collaborative group has been created to register, standardize the procedure, selection of patients, and assess the outcome, highlighting the need for ongoing discussion and research. A broad questionnaire was sent to all the groups worldwide known to us performing this procedure. Results of this questionnaire are the goal of this manuscript, aiming to present the procedure, experiences, problems, and lessons learned with this procedure. The thirteen respondents currently practicing this technique were categorized based on case volume and experience. Results show varied surgical indications, with higher-volume centers displaying less selectivity. Slightly different surgical approaches were reported, with the left transcervical and abdominal transhiatal dissection being the basis techniques. Surgeons reported high rates of R0 resection and lymph node harvested, low rates of pulmonary complications and anastomotic leaks, but high rates of recurrent laryngeal nerve injuries. The collaborative group aims to align techniques, share experiences, and standardize procedures. Despite concerns about recurrent laryngeal nerve injuries, not different from other total mediastinal lymphadenectomy techniques, the procedure shows promise in reducing pulmonary complications, marking a crucial step toward global acceptance. Future efforts will focus on standardization, comparative studies, and training protocols.