Abstract
Introduction: Esophageal cancer ranks 8th among the most common malignancies. Management of esophageal cancer is complex and involves multidisciplinary team approach. Esophagectomy is a complex procedure with significant morbidity. The surgical approach to the oesophagus depends on a lot of factors like the anatomical location of the disease in the oesophagus, histopathology, desired lymphadenectomy and surgeon preferences. Historically the approach to esophageal resection was via open surgery. Minimally invasive surgery has revolutionized the management of esophageal surgery. The concept of Minimally invasive esophagectomy (MIE) was introduced to lessen the morbidity associated with open surgery. Less surgical trauma and hence less injury and inflammation are thought to play a vital part in reducing surgical stress and associated morbidity. Minimally invasive three-stage esophagectomy is carried out for tumours of the upper and middle oesophagus, hence mostly for squamous cell carcinomas as they predominate in this region.
Methods: We report a case of carcinoma oesophagus that was managed by minimally invasive three-stage esophagectomy. At our institute, Shaukat Khanum Memorial Cancer Hospital and Research Center (SKMH&RC) we routinely perform minimally invasive esophagectomy. We perform the thoracic part first in the left lateral position via the Video Assisted Thoracoscopic Surgery (VATS) approach, then the patient is placed in a modified Lloyd Davis position and the abdominal part is performed via laparoscopic approach and simultaneously neck is dissected and later anastomosis is fashioned in the neck.
Results: The patient underwent the procedure safely and was discharged on day five after surgery. It was an adequate oncological resection.
Conclusion: Minimally invasive three-stage esophagectomy is a safe procedure with less morbidity and equal oncological outcomes in high volume centres.

Key words: Esophageal cancer, Esophagectomy, Minimally invasive esophagectomy, Video assisted thoracoscopic surgery, Laparoscopy