PS01.244: MINIMALLY INVASIVE ESOPHAGECTOMY FOR ESOPHAGEAL CANCER WITH THE PATIENT IN PRONE POSITION: EXPERIENCE OF 156 CONSECUTIVE CASES IN A SINGLE CENTER

Background Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome. Methods Between July 2005 and December 2017, 156 patients underwent minimally invasive esophagectomy in the prone position at the authors' institutionin. Was performed 132 three field McKeown MIE (84,6%) with circular stapled cervical anastomosis and 24 two field Ivor Lewis MIE (15,4%) with circular stapled intrathoracic anastomosis; For four patients (2,6%) the colon was used for cervical anastomosis, and two patients (1,3%) had previously undergone left pneumonectomy because of lung cancer. The preoperative indication was squamous cell carcinoma for 100 patients (64,1%) and adenocarcinoma for 53 patients (33,9%). In three cases (1,9%), the histology of the specimen showed a squamous cell carcinoma with neuroendocrine differentiation. Neoadjuvant treatment was administered to 79 patients (50,6%) Results In 152 patients (97,4%) was performed esophagectomy using minimally invasive thoracic mobilization of the esophagus with the patient in prone position. In four cases (2,6%) an early thoracotomic conversion was necessary due to the presence of lung adhesions such that made it impossible to establish the pneumothorax. The mean operative time was 255 min (range: 130–420 min). The median intensive care unit stay was 2 days (range: 0–77 day), and the median postoperative hospital stay was 15 days (range: 8–79 day). The mean number of procured lymph nodes was 16 (range: 0–56 Ln). The perioperative pulmonary morbidity rate was 22,4%, and the perioperative mortality rate was 2.6%. An anastomotic leakage occurred in 13 patients (8,3%). Conclusion Minimally invasive esophagectomy is safe and technically feasible. It entails a lower mortality rate and a shorter hospital stay than those reported in most open series. Thoracoscopy with the patient in prone position offers results comparable with those obtained using other minimally invasive techniques.This technique shows considerable advantages such as improved surgeon ergonomics, increased operative field exposure, and satisfactory respiratory results. Disclosure All authors have declared no conflicts of interest.