Upper GI Surgery Evidence Evolution

5 evidence evolution narratives tracing how landmark trials and guideline updates reshaped upper gi surgery practice.

Esophagectomy Surgical Approach

Minimally invasive gains ground

Open → MIE (MIRO/TIME) → hybrid → ROBOT trial → recovery and outcomes

POEM challenges Heller

Pneumatic dilation → Heller myotomy → laparoscopic Heller → POEM (2010) → European Achalasia Trial → head-to-head

D2 prevails

D1 West → DUTCH D1 vs D2 → D2 long-term superior → Japanese evidence → laparoscopic D2

To mesh or not to mesh

Primary repair recurrence → synthetic mesh → biological mesh → ATLAS RCT → ongoing debate

Multimodal standard of care

Surgery-first → MAGIC → CROSS (2012) → CheckMate 577 adjuvant → neoadjuvant immunotherapy