Abstract
BackgroundThe rates of thoracoscopic esophagectomy performed in the prone and left lateral decubitus positions are similar in Japan. We retrospectively reviewed short- and long-term outcomes of thoracoscopic esophagectomy for esophageal cancer performed in the left lateral decubitus position.MethodsBetween 1996 and 2015, 654 patients with esophageal cancer underwent thoracoscopic esophagectomy in the left lateral decubitus position. Patients were divided into early (1996–2008) and late groups (2009–2015, with standardization of the procedure and formalized training), and their clinical outcomes reviewed.ResultsThe completion rate of thoracoscopic esophagectomy was 99.5%, and the procedure was converted to thoracotomy in three patients, due to hemorrhage. The mean intrathoracic operative time, intrathoracic blood loss, and number of dissected mediastinal lymph nodes were 205.0 min, 127.3 mL, and 24.7, respectively. Postoperative complications included pneumonia (8.5%), anastomotic leakage (7.5%), and recurrent nerve paralysis (3.5%). Postoperative (30d) mortality was 4/654 (0.61%) due to anastomotic leak and pneumonia. The five year overall survival rate was 70%. A comparison of the 289 early- and 365 late-study period cases revealed significant differences in mean intrathoracic blood loss (174.0 vs. 94.2 mL), number of mediastinal lymph nodes dissected (20.0 vs. 28.4), hospital length of stay (33.4 vs. 20.0 days, p < 0.001), and postoperative anastomotic leakage (14% vs. 1.6%, p < 0.0001).ConclusionsStandardization of the procedure for thoracoscopic esophagectomy in the left lateral decubitus position, with a standardized clinical pathway for perioperative care led to significant improvements in surgical outcomes.
Highlights
The rates of thoracoscopic esophagectomy performed in the prone and left lateral decubitus positions are similar in Japan
Palanivelu et al first described thoracoscopic esophagectomy in the prone position in 2006, [9] and many surgeons in Japan perform the operation with the patient in this position, [10, 11] with a similar number of resections performed in the left lateral decubitus position
We investigated the shortand long-term outcomes of these 654 patents with esophageal cancer treated with thoracoscopic resection in the left lateral decubitus position over the last 20 years and compared early (1996–2008) and late (2009–2015) study periods
Summary
We retrospectively reviewed short- and long-term outcomes of thoracoscopic esophagectomy for esophageal cancer performed in the left lateral decubitus position. Palanivelu et al first described thoracoscopic esophagectomy in the prone position in 2006, [9] and many surgeons in Japan perform the operation with the patient in this position, [10, 11] with a similar number of resections performed in the left lateral decubitus position. We began performing complete thoracoscopic esophagectomy in the left lateral decubitus position in 1996, and from November 1996 to July 2015, performed 654 procedures using this approach. We investigated the shortand long-term outcomes of these 654 patents with esophageal cancer treated with thoracoscopic resection in the left lateral decubitus position over the last 20 years and compared early (1996–2008) and late (2009–2015) study periods
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