In this review we outline the recent updates in the perioperative management of esophagectomy, especially in McKeown esophagectomy, focusing on preoperative risk assessment, intraoperative management, and perioperative support by multidisciplinary teams to improve operative outcomes.

There were advantages and disadvantages in relation to the short-term outcomes of robot-assisted minimally invasive McKeown esophagectomy (RAMIE-MK) as compared with completely minimally invasive McKeown esophagectomy (CMIE-MK). However, there were no significant differences in the long-term outcomes between RAMIE-MK and CMIE-MK. The short-term and mid-term outcomes between robot-assisted minimally invasive transmediastinal esophagectomy (RATME) and open transmediastinal esophagectomy (OTME) were also compared. Although RATME has some disadvantages, such as a higher rate of pulmonary complications as compared with OTME, these are expected to be overcome in the future.

The era of ultimate minimally invasive surgery and personalized treatment has begun. Large, prospective studies will be required to confirm the value of these advancements for esophageal cancer.