Minimally Invasive Esophagectomy in the Lateral-prone Position: Experience of 226 Cases.

BACKGROUND: An open esophagectomy for esophageal cancer is a severely invasive procedure. Minimally invasive esophagectomy (MIE) has emerged as an effective alternative to open techniques. Conventionally, a thoracoscopic procedure is performed either in the left lateral decubitus position or in the prone position. Both positions have their disadvantage during the mobilization of the esophagus. In this study, we applied a novel position: the left lateral-prone position in the throacoscopic phase of MIE; we also describe the details of the technique and its feasibility, and present the initial results of this large-volume series.

METHOD: We performed 226 cases of MIEs for esophageal cancer successfully from February 2008 to September 2014. All patients received thoracoscopic mobilization of the esophagus, followed by larparoscopic mobilization of the stomach and cervical anastomosis (McKeown or 3-field lymphadenectomy dissection esophagectomy). The throacoscopic part was performed in the left lateral-prone position. Perioperative data and the surgical outcome were studied retrospectively.

RESULT: Of the 226 patients, 131 were men (57.9%) and 95 (42.1%) were women, with a median age of 64.5 years. All procedures were completed by thoracoscopy and laparoscopy, except 3 cases of conversion to open thoracotomy and 2 conversions to open laparotomy. Two-field lymphadenectomy was performed in 89 patients. Three-field lymphadenectomy was performed in 137 patients. Only 6 (2.7%) patients required blood transfusion. Postoperative morbidity was encountered in 78 (34.5%) patients, and anastomotic leak occurred in 9 cases (4.0%). Vocal cord paralysis was found in 11 cases (4.9%). The mean number of lymph nodes harvested was 21. The 30-day postoperative mortality rate was 1.3% (n=3). The mean length of hospital stay was 12.7 days.

CONCLUSIONS: MIE in the lateral-prone position is technically less demanding and provides better technical safety, with good oncological effectiveness. This positioning is a feasible and appropriate alternative for minimally invasive surgery of esophageal carcinoma.