Totally Versus Hybrid Minimally Invasive Esophagectomy for Esophageal Cancer

Inclusion Criteria:

Inclusion criteria for screening - part A (for patients receiving a neo-adjuvant treatment)

* Age ≥ 18 years and ≤ 80 years For patients between 70 and 80 years old : score G8 ≥ 14 or oncogeratrician approval
* Squamous cell carcinoma or adenocarcinoma of the esophagus or esogastric junction
* Clinical stage T1, T2, T3, T4a, N0-N3, M0 before any treatment
* Tumors of the middle or lower third of the esophagus, or tumor of the esogastric junction Siewert 1 or 2
* With or without neoadjuvant (radio) chemotherapy ± targeted therapy
* Disease deemed curatively resectable preoperatively
* Requiring a 2-stage Ivor-Lewis esophagectomy
* Performance status 0, 1 or 2
* Patient capable of receiving either surgical treatment
* Patient informed of the terms of the study and having given written consent
* Patient able to read and understand the language and content of the study documents and agreeing to adhere to the protocol requirements.
* Covered by a medical/health insurance
* Willingness and ability to comply with scheduled visits and study procedures

Inclusion criteria before surgery (after neo-adjuvant treatment or for patients receiving primary surgery)

* Age ≥ 18 years and ≤ 80 years For patients between 70 and 80 years old : score G8 ≥ 14 or oncogeratrician approval
* Squamous cell carcinoma or adenocarcinoma of the esophagus or esogastric junction
* Clinical stage T1, T2, T3, N0-N3, M0 before surgery
* Tumors of the middle or lower third of the esophagus, or tumor of the esogastric junction Siewert 1 or 2
* With or without neoadjuvant (radio) chemotherapy ± targeted therapy
* Disease deemed curatively resectable preoperatively
* Requiring a 2-stage Ivor-Lewis esophagectomy
* Performance status 0, 1 or 2
* Patient capable of receiving either surgical treatment
* Patient informed of the terms of the study and having given written consent
* Patient able to read and understand the language and content of the study documents and agreeing to adhere to the protocol requirements.
* Covered by a medical/health insurance
* Willingness and ability to comply with scheduled visits and study procedures

Exclusion Criteria:

Non inclusion criteria for screening - part A (for patients receiving a neo-adjuvant treatment)

Patient-related non-inclusion criteria

* Performance status 3 or 4
* Documented liver cirrhosis or portal hypertension
* Recent myocardial infarction (less than 6 months old) or progressive coronary artery disease
* Distal arteritis from stage IIb (200 m) of Leriche and Fontaine
* Synchronous cancer, other than subcarinal esophageal
* Neoplasic history except for cancers without recurrence after at least 5 years of surveillance
* History of xyphopubic laparotomy
* Patients with prior thoracic surgery or thoracic traum of the right hemithorax
* Patient refusal
* Patient under guardianship or curatorship
* Pregnant or breastfeeding woman or patient expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 6 months after the last dose of adjuvant chemotherapy
* ASA score\> 3

Disease-related non-inclusion criteria

* Histology other than squamous cell carcinoma or adenocarcinoma
* Tumors of the upper third of the thoracic esophagus, cervical esophagus or pharyngo-esophageal junction or tumor of the esogastric junction Siewert 3
* Supraclavicular nodes invaded clinically or on puncture
* Recurrent nerve paralysis
* Evidence of extension to the tracheobronchial tree
* Signs of mediastinal invasion (vertebral adhesion, aortic overlap \> 90°, invasion of unresectable neighboring organs such as the aorta, trachea…)
* Distant metastatic extension

Non inclusion criteria before surgery (after neo-adjuvant treatment or for patients receiving primary surgery)

* Performance status 3 or 4
* Forced expiratory volume in 1 second \< 1000 ml
* Documented liver cirrhosis or portal hypertension
* Recent myocardial infarction (less than 6 months old) or progressive coronary artery disease
* Distal arteritis from stage IIb (200 m) of Leriche and Fontaine
* Weight loss of more than 15% of body weight, not recovered after appropriate nutritional management
* Synchronous cancer, other than subcarinal esophageal
* Neoplasic history except for cancers without recurrence after at least 5 years of surveillance
* History of xyphopubic laparotomy
* Patients with prior thoracic surgery or thoracic traum of the right hemithorax
* Patient refusal
* Patient under guardianship or curatorship
* Pregnant or breastfeeding woman or patient expecting to conceive or father children within the projected duration of the study, starting with the screening visit through 6 months after the last dose of adjuvant chemotherapy
* ASA score\> 3
* IESG ≤ -5 (Very high risk patients)

Disease-related non-inclusion criteria

* Histology other than squamous cell carcinoma or adenocarcinoma
* Tumors of the upper third of the thoracic esophagus, cervical esophagus or pharyngo-esophageal junction or tumor of the esogastric junction Siewert 3
* Supraclavicular nodes invaded clinically or on puncture
* Recurrent nerve paralysis
* Evidence of extension to the tracheobronchial tree
* Signs of mediastinal invasion (vertebral adhesion, aortic overlap \> 90°, invasion of unresectable neighboring organs such as the aorta, trachea…)
* Distant metastatic extension