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Recent Clinical Advances in Esophageal Surgery
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Recent Clinical Advances in Esophageal Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: 15 July 2026 | Viewed by 2482

Editors

Dr. Guy Pines

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Guest Editor
1. Department of Thoracic and Esophageal Surgery, Kaplan Medical Center, POB 1, Rehovot 76100, Israel
2. Medical School, Hebrew University, Jerusalem, Israel
Interests: thoracic surgery; lung cancer; thoracic oncology; esophageal cancer; gastric cancer; benign esophageal disorders; surgical education
Dr. James Tankel

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Guest Editor
Department of General Surgery, Shaare Zedek Medical Center, The Hebrew University School of Medicine, Jerusalem, Israel
Interests: esophagus; gastric; carcinoma; neoadjuvant therapy
Dr. Harbi Khalayleh

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Guest Editor
Department of Surgery, Kaplan Medical Center, Rehovot and the Hebrew University Medical School, Jerusalem, Israel
Interests: laparoscopic surgery; gastric cancer; surgical oncology; esophageal neoplasm

Special Issue Information

Dear Colleagues,

Esophageal surgery is currently undergoing a period of remarkable development and profound change, driven by technological innovation and evolving clinical understanding. These rapid advances are crucial for improving patient outcomes in both advanced esophageal cancer and challenging benign disorders. This Special Issue, “Recent Clinical Advances in Esophageal Surgery,” aims to evaluate and discuss the latest cutting-edge diagnostic and therapeutic strategies across the full spectrum of esophageal pathology.

We welcome contributions addressing the continuous progression of minimally invasive surgery for esophageal cancer, including the impact of robotic surgery. Furthermore, papers focusing on the management of the effect of immunotherapy on advanced esophageal cancer are welcome. Papers dealing with early-stage disease management, such as endoscopic resection, are highly encouraged. A significant focus of this issue is also dedicated to the contemporary surgical management of benign esophageal disorders, covering innovations in the treatment of challenging conditions like complex paraesophageal hernias, anti-reflux surgery and motility disorders. In this Special Issue, original research articles and reviews are welcome, reporting experience and knowledge in this dominant research area.

We look forward to receiving your contributions and fostering a discussion that will further advance the future of esophageal surgery.

Dr. Guy Pines
Dr. James Tankel
Dr. Harbi Khalayleh
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • esophageal surgery
  • minimally invasive surgery
  • esophageal cancer
  • robotic surgery
  • endoscopic resection
  • benign esophageal disorders
  • paraesophageal hernia
  • anti-reflux surgery
  • motility disorders

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Published Papers (4 papers)

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16 pages, 1961 KB  
Article
One-Lung Ventilation Duration Is a Risk Factor for Pneumonia in Minimally Invasive and Robotic Esophagectomy
by Vladimir J. Lozanovski, Julian Kobler, Edin Hadzijusufovic, Franziska Renger, Christoph Wandhoefer, Eva-Verena Griemert, Hauke Lang and Peter P. Grimminger
J. Clin. Med. 2026, 15(10), 3832; https://doi.org/10.3390/jcm15103832 - 15 May 2026
Viewed by 311
Abstract
Introduction: Postoperative pulmonary complications, particularly pneumonia, remain frequent after esophagectomy and contribute significantly to morbidity. One-lung ventilation (OLV) is a potential modifiable risk factor, but its impact in minimally invasive (MIE) and robot-assisted Ivor Lewis esophagectomy (RAMIE) within European populations is not well [...] Read more.
Introduction: Postoperative pulmonary complications, particularly pneumonia, remain frequent after esophagectomy and contribute significantly to morbidity. One-lung ventilation (OLV) is a potential modifiable risk factor, but its impact in minimally invasive (MIE) and robot-assisted Ivor Lewis esophagectomy (RAMIE) within European populations is not well defined. Methods: 619 patients undergoing MIE or RAMIE were analyzed. OLV duration was extracted from operative records. Postoperative pneumonia incidence, overall survival, and perioperative outcomes were assessed. ASA classification and other risk factors were considered. Results: The overall incidence of postoperative pneumonia was 18.6%, with no significant difference between MIE (20.4%) and RAMIE (18.2%). Prolonged OLV duration increased pneumonia risk by 4% per 10 min. Female sex and higher ASA classification were also significant risk factors. Likely reflecting early diagnosis and advanced perioperative management, pneumonia did not affect overall survival, which remained comparable between MIE and RAMIE. Conclusions: Prolonged OLV during MIE and RAMIE increases the risk of postoperative pneumonia without significantly affecting overall survival, reflecting effective complication management. OLV duration may serve as a practical intraoperative indicator to guide risk stratification and optimize postoperative care in minimally invasive and robot-assisted Ivor Lewis esophagectomy. Full article
(This article belongs to the Special Issue Recent Clinical Advances in Esophageal Surgery)
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18 pages, 593 KB  
Systematic Review
Esophageal Schwannoma—Systematic Review of Clinicopathologic Factors and Treatment
by Rashad Khazen, Raneem Bader, George Asfour, Barak Bar-Zakai, Guy Pines and Harbi Khalayleh
J. Clin. Med. 2026, 15(8), 2862; https://doi.org/10.3390/jcm15082862 - 9 Apr 2026
Cited by 1 | Viewed by 529
Abstract
Background: Esophageal schwannomas are extremely rare, benign mesenchymal tumors originating from the nerve sheath tissues of autonomic nerves, accounting for less than 2% of all esophageal tumors. This systematic review aims to provide a detailed analysis of esophageal schwannomas (ESs), focusing on [...] Read more.
Background: Esophageal schwannomas are extremely rare, benign mesenchymal tumors originating from the nerve sheath tissues of autonomic nerves, accounting for less than 2% of all esophageal tumors. This systematic review aims to provide a detailed analysis of esophageal schwannomas (ESs), focusing on tumor characteristics, diagnostic methods, and treatment options. Methods: A systematic search of English literature databases, including ScienceDirect, Springer, PubMed, and Google Scholar, was conducted up to 2023. The keywords used were ‘esophageal schwannoma,’ ‘gastrointestinal schwannoma,’ ‘esophageal neurinoma,’ and ‘esophageal neurilemoma.’ Studies were reviewed for patient demographics, clinical presentation, diagnostic methods, tumor characteristics, and management options. Results: A total of 370 articles met the inclusion criteria, with 80 articles (89 cases) included in the final analysis. The mean age of patients was 51.8 years, with a female predominance (73%). Most cases were reported from East Asia (60.7%). Most (71%) patients presented with dysphagia, and 12% were asymptomatic. Preoperative diagnosis often involved CT scans (75.28%), upper endoscopy (73.03%), and EUS (49.4%). Tumors averaged 77.86 mm in size as per CT, MRI and PET-CT, with the upper esophagus being the most common location (55.55%). Surgical resection was the primary treatment, with enucleation being the most frequent procedure (58.9%). The prognosis was generally excellent, with no reported recurrences during follow-up periods. Conclusions: Esophageal schwannomas are extremely rare. Surgical resection remains the treatment of choice, with a high success rate and excellent prognosis. Further studies are needed to standardize diagnostic and treatment protocols for these rare tumors. Full article
(This article belongs to the Special Issue Recent Clinical Advances in Esophageal Surgery)
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18 pages, 919 KB  
Systematic Review
Prognostic Impact and Postoperative Management Following Poor Pathological Response to Perioperative FLOT in Resectable Gastric and GEJ Adenocarcinoma: A Systematic Review and Meta-Analysis
by Ismaell Massalha, Reem Zabit, Samer Hussany, Adham Hijab, Wael Hozaeel, Israel Sandler, Jamal Zidan, Ory Wiesel and Ravit Geva
J. Clin. Med. 2026, 15(6), 2367; https://doi.org/10.3390/jcm15062367 - 20 Mar 2026
Cited by 1 | Viewed by 756
Abstract
Background: Pathological tumor regression is a key prognostic marker in resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma. Perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) established the modern treatment backbone, and the recent MATTERHORN trial further intensified this paradigm with the addition of durvalumab. However, [...] Read more.
Background: Pathological tumor regression is a key prognostic marker in resectable gastric and gastroesophageal junction (GEJ) adenocarcinoma. Perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, docetaxel) established the modern treatment backbone, and the recent MATTERHORN trial further intensified this paradigm with the addition of durvalumab. However, a substantial proportion of patients fail to achieve major pathological regression, and the prognostic magnitude of poor response in the FLOT era has not been systematically quantified. Methods: We performed a PRISMA 2020–compliant, PROSPERO registered (CRD420251150054) systematic review and meta-analysis. PubMed, Web of Science, Scopus, and Cochrane were searched through September 2025 for studies including patients with resectable gastric/GEJ adenocarcinoma treated with perioperative FLOT followed by curative surgery. Associations between poor pathological response and survival were quantified. Exploratory analyses evaluated completion of postoperative FLOT versus incomplete therapy. Random effects models were applied to pooled hazard ratios (HRs). Results: Twelve studies comprising 4201 resected patients were included in this systematic review; 1817 (43.2%) were classified as poor responders. Poor pathological response was strongly associated with inferior outcomes: pooled HR for overall survival (OS) was 2.73 (95% CI 2.18–3.43; I2=0.0%) and pooled HR for disease-free/recurrence-free survival (DFS/RFS) was 2.68 (95% CI 2.14–3.34; I2=51.2%). Effect direction was consistent across Becker, Mandard, and CAP grading systems. Exploratory analysis of three observational cohorts found an association between completion of postoperative FLOT and improved survival (HR 0.49, 95% CI 0.31–0.79); however, this comparison is inherently confounded by postoperative fitness and treatment selection and should not inform clinical decision-making. Conclusions: Poor pathological response after perioperative FLOT identifies a large, high risk subgroup with approximately threefold inferior survival despite R0 resection. These findings establish contemporary prognostic benchmarks and underscore the absence of prospective evidence guiding postoperative management in poor responders. Full article
(This article belongs to the Special Issue Recent Clinical Advances in Esophageal Surgery)
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13 pages, 1037 KB  
Systematic Review
Artificial Intelligence in Esophagectomy: A Systematic Review
by Vladimir Aleksiev, Daniel Markov, Kristian Bechev, Desislav Stanchev, Filip Shterev and Galabin Markov
J. Clin. Med. 2026, 15(6), 2169; https://doi.org/10.3390/jcm15062169 - 12 Mar 2026
Viewed by 611
Abstract
Background: Esophagectomy remains a technically demanding oncologic procedure with substantial morbidity, despite ongoing advances in minimally invasive and robotic techniques. Limitations in intraoperative visualization and anatomical recognition contribute to complications such as nerve injury and bleeding. Artificial intelligence (AI)-based intraoperative video analysis [...] Read more.
Background: Esophagectomy remains a technically demanding oncologic procedure with substantial morbidity, despite ongoing advances in minimally invasive and robotic techniques. Limitations in intraoperative visualization and anatomical recognition contribute to complications such as nerve injury and bleeding. Artificial intelligence (AI)-based intraoperative video analysis has emerged as a potential adjunct to enhance surgical perception and safety, but its application in esophagectomy has not been comprehensively reviewed. Methods: A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Web of Science were searched without a lower date limit to identify eligible studies published up to January 2026, capturing early and contemporary applications of intraoperative AI in esophagectomy. Human studies involving any surgical approach were included. Data on the AI task, methodology, validation strategy, performance metrics, and reported clinical outcomes was extracted. Risk of bias was assessed using the ROBINS-I tool. Results: Six studies met the inclusion criteria, predominantly evaluating AI-driven analysis of intraoperative video during minimally invasive or robotic esophagectomy. Reported applications included real-time anatomical structure recognition, recurrent laryngeal nerve segmentation, detection of excessive nerve traction, instrument and event recognition, and surgical phase identification. Across studies, AI systems demonstrated performance comparable to expert surgeons for selected tasks and achieved real-time or near–real-time inference. One study reported earlier detection of excessive recurrent laryngeal nerve traction compared to conventional nerve integrity monitoring. However, most studies were retrospective, single-center, and feasibility-focused, with limited external validation and minimal assessment of patient-centered clinical outcomes. Conclusions: Artificial intelligence-based intraoperative analysis in esophagectomy is increasingly achievable and may enhance anatomical recognition, intraoperative risk detection, and procedural awareness. Nevertheless, current evidence remains preliminary, heterogeneous, and largely exploratory. Prospective, multicenter studies with standardized reporting and clinically meaningful outcome evaluation are required before routine implementation. Until such data is available, AI should be regarded as a complementary intraoperative tool rather than a standalone clinical decision-making system. Full article
(This article belongs to the Special Issue Recent Clinical Advances in Esophageal Surgery)
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