391. MINIMALLY INVASIVE ESOPHAGECTOMY IN PRONE POSITION. INITIAL EXPERIENCE OF NATIONAL CANCER INSTITUTE MEXICO

Abstract

Abstract Transthoracic approach in esophageal cancer increases oncologic outcomes but open surgery associates with poor respiratory outcomes. Minimally invasive thoracoscopic (MIT) has been selected for minimizing postoperative complications and faster recovery. It is thought that long term outcomes are equivalent to open surgery. Prone position (PP) is becoming more world important because it reduces respiratory complications and blood loss. It provides a clean surgical field and allows more lymph node harvests due to the better exposure. Observing the benefits of PP to perform esophagectomy in cancer patients, we obtained pre-certification in Japan and started in 2017. This is a retrospective study in patients with esophageal cancer operated from January 2017 to December 2021 in the National Cancer Institute. We used AJCC 8th to clinical stage; early stage was operated and locally advanced stage did neoadjuvant treatment and surgery. Our surgical results show complications and mortality on postoperative day 60 (Clavien-Dindo and ECCG classification) and short oncological results in PP-MIT esophagectomy. There were 25 PP-MITesophagectomies, median age was 57 y.o. and 84% were men. The general characteristics are indicated in image 1. The main clinical stages were locally advanced in 96% (CS III and IVA), all received neoadjuvant therapy (80% QT/RT) with a partial response of 76%. The major complications (Clavien >3) were 12% and one patient died of arrhythmia on the 10th day. Complications were classified by using the ECCG classification, are shown in image 1. The pathological results are in image 1. The mean survival was 32.1 (24.8–39.5) months and cancer specific survival was 76%. Esophagectomy has a high risk of complications and mortality and is one of the most complex surgeries in the digestive tract. In our cancer institute, we separated surgical groups to place experts in each area. Our initial experience of PP-MIT esophagectomy was a good oncological control with low complications, despite advanced cancer with poor prognosis requiring multimodal treatment.