Indication and limitation of endoscopic surgical procedure for esophageal cancer

Our standard procedure of thoracoscopic esophagectomy and indication of endoscopic surgery for thoracic esophageal cancer are described. The thoracoscopic esophagectomy is performed for cases without direct invasion to the adjacent structures, without massive lymph node involvement, and tolerable to left ipsi-lateral ventilation during surgery. Total operation time, time of thoracic procedure, and harvested lymph node of the past 243 thoracoscopic esohpagectomy cases are the same as the conventional open surgery. The blood loss of the thoracoscopic esophagectomy is less than that of the open. In the long-term outcome, decreasing of the vital capacity is less in the thoracoscopic than open. Concerning to the postoperative complications, pneumonia and palsy of the recurrent laryngeal nerves occurred more frequently in the thoracoscopic surgery than open, but pneumonia has been getting less since introduction of the laparoscopic abdominal procedure. In conclusion, as manners of thoracoscopic esophagectomy and laparoscopic abdominal procedure differs in each hospital and have not yet approved, this surgery likely develops to a standard alternative once learning a high quality and sophisticated surgical maneuver under excellent magnified endoscopic view.