Optimizing Perioperative and Surgical Strategies in Esophageal Cancer

Surgical removal of the esophagus is an essential part of curative treatment for esophageal cancer. Although treatment outcomes have improved considerably over the past decades, esophagectomy remains one of the most complex procedures in cancer surgery and is associated with prolonged recovery and a substantial risk of complications. Therefore, continuous efforts are needed to optimize patient care before, during, and after surgery.

The first part of this thesis addresses perioperative care for patients undergoing esophagectomy. It evaluates different aspects of Enhanced Recovery After Surgery (ERAS) programs, which aim to standardize and optimize care throughout the surgical pathway. By examining current perioperative strategies, this research explores how ERAS can contribute to faster recovery, fewer complications, and improved patient outcomes, while also highlighting that several aspects of perioperative care continue to evolve and require further evaluation.

The second part of this thesis explores recent advances in esophageal surgery, with particular attention to robot-assisted minimally invasive esophagectomy (RAMIE). This innovative surgical technique was introduced to overcome some of the technical challenges of conventional minimally invasive surgery. The studies presented in this thesis investigate different surgical approaches within RAMIE and their impact on postoperative outcomes, while emphasizing the importance of structured training, multidisciplinary collaboration and careful evaluation to ensure its safe implementation.

Overall, this thesis demonstrates that high-quality esophageal cancer care requires a centralized, multidisciplinary approach, with patients actively involved throughout the treatment pathway. The findings underline the importance of continuously evaluating and optimizing perioperative care, strengthening collaboration between healthcare professionals, and further advancing robot-assisted surgery. As surgical techniques and robotic technology continue to evolve, these innovations have the potential to further improve patient outcomes and the quality of care for individuals with esophageal cancer.