The first randomised controlled trial on minimally invasive esophagectomy (MIE) and the ongoing quest for greater evidence

Esophagectomy remains a key component in the multi modality treatment of cancer of the esophagus. The incidence of esophageal adenocarcinoma has increased worldwide (1-2) and so the impetus for researching more efficacious methods for treating this disease has been growing especially in the area of minimally invasive techniques. An international survey report in 2009 covering 41 countries found that 52% of responders preferred open transthoracic approach over transhiatal esophagectomy (THE) or minimally invasive esophagectomy (MIE). Transhiatal esophagectomy was preferred by 26% of responders and MIE, by 14% (3). Certainly, MIE is far from being adopted as common practice. The cost of MIE in terms of material and training is significant and therefore a clear benefit to patients must be established prior to its adoption.