Esophagectomy is a mainstay of treatment for esophageal cancer [[1], [2], [3]]. Traditionally, esophageal cancer is associated with high morbidity and mortality [4]. With the advent of minimally invasive esophagectomy, outcomes for transthoracic esophagectomy have been promising, with faster recovery and less morbidity [5,6]. Yet, there remain disadvantages related to a transthoracic approach, namely, morbidity associated with thoracotomy, the need for a single lung ventilation, atelectasis and respiratory compromise, as well as potentially harmful sequelae of an intrathoracic anastomotic leak [7].

While transhiatal esophagectomy (THE) avoids thoracotomy and is associated with reduced lung morbidity, this comes at the cost of sacrificing mediastinal lymphadenectomy [8]. Recent reports have shown that mediastinoscopy-assisted transhiatal esophagectomy (MATHE) allows for en-bloc dissection of mediastinal lymph nodes, thus removing this disadvantage of THE, while potentially retaining the benefits of this approach [9,10]. MATHE is a relatively novel approach that combines mediastinoscopy with laparoscopy and primarily involves thoracic esophagus mobilization, lymphadenectomy under mediastinoscopic visualisation, as well as laparoscopic gastric dissection, abdominal lymph node dissection and gastroesophageal neck anastomosis. Hence, the increase in mediastinal operation space through a MATHE approach allows for better visualisation and exposure of the upper mediastinum anatomy of the trachea, thoracic duct, and azygos vein [11].

However, there is a paucity of literature with regards to the outcomes of MATHE. Accordingly, this study aimed to conduct the first meta-analysis to explore the efficacy of MATHE and clarify its role in the future of esophageal surgery.