Short-term outcomes and one surgeon's learning curve for thoracoscopic esophagectomy performed with the patient in the prone position.

Abstract

Thoracoscopic esophagectomy with the patient in the prone position (TEP) is now being performed as minimally invasive esophagectomy for esophageal cancer. This study examines the short-term outcomes and the learning curve associated with TEP. One surgeon ("Surgeon A") performed TEP on 100 consecutive patients assigned to three periods based on treatment order. Each group consisted of 33 or 34 patients. The outcomes of the three groups were compared to define the influence of surgeon expertise. Outcomes improved as Surgeon A gained experience in performing this operation, as evidenced by reduced thoracic operative times between periods 1 and 2, and then between periods 2 and 3 (p=0.0033 and p=0.0326, respectively); an increased number of retrieved chest nodes between periods 1 and 2 (p=0.0070); and a decline in recurrent laryngeal nerve (RLN) palsy between periods 2 and 3 (p=0.0450). Period 2 was the pivotal period for each learning curve. An individual surgeon's learning curve over the course of 100 TEP procedures had three outcomes: a shortened operative time, a higher number of retrieved chest nodes, and a decreased rate of RLN palsy. Approximately 30-60 cases were needed to reach a plateau in the TEP procedure and a reduction in the morbidity rate.