Open Versus Laparoscopically-assisted Esophagectomy for Cancer

Inclusion Criteria:

* Squamous cell or adenocarcinoma of the thoracic esophagus T1, T2, T3, N0-N1, M0, before any treatment
* Middle or lower third esophageal carcinoma, junctional tumor Siewert type I
* Patients who underwent or not neoadjuvant chemotherapy or chemoradiation
* Tumor deemed to be resectable in a curative intent at the preoperative setting
* Age less than 75 years old, OMS status 0, 1 or 2
* Patient who can undergo one or the other surgical modality
* Written informed consent form
* Possible follow-up

Exclusion Criteria:

1. General criteria: PO2 ≤ 60 mmHg; PCO2 \> 45 mmHg; FEV ≤ 1000 ml/sec

   * Hepatic cirrhosis
   * Recent myocardial infarction (in the previous 6 months) or progressive coronary disease
   * Distal arteritis (Leriche-Fontaine stage II upwards)
   * Concomitant cancer, other than subcarinal esophageal cancer
2. Disease-related factors

   * Invasion of subclavicular lymph nodes in a clinical examination or on biospy
   * Lymph nodes near the origin of the celiac artery with a diameter ≥ 1 cm on CT or that appear to be suspect on endoscopic ultrasound (to differentiate them from the paracardial or left gastric lymph nodes, which does not constitute an exclusion criterion)
   * Recurrent nerve palsy
   * Evidence of extension to the tracheobronchial tree
   * Signs of mediastinal invasion (vertebral contact, aortic contact ≥ 90°, or invasion of nonresectable neighboring organs such as the aorta, trachea, main bronchi, etc.)
   * Distant metastasis
3. Laparoscopy-related factors

   * Patient presenting a general contraindication to laparoscopy
   * A history of median or subcostal laparotomy