Thoracoscopic Esophagectomy for Esophageal Cancer in the Prone Position

Abstract Background Thoracoscopic esophagectomy has been performed for two decades and becomes widely spread. We evaluate our cases who undergone the thoracoscopic esophagectomy and consider the future prospective of this operation. Methods 702 patients who received thoracoscopic esophagectomy in our institute from March 1995 to October 2017 were enrolled and studied retrospectively. Operative indication is an all of the clinically resectable cases including with a neoadjuvant treatment or definitive chemoradiotherapy before surgery. Overall survival rate of the patients with thoracoscopic approach and with thoracotomy until 2001 was analyzed. Long term outcome of the patients with thoracoscopic esophagectomy was compared to the result from comprehensive registry of esophageal cancer in Japan. Short term results of the perioperative parameters were analyzed between left lateral decubitus position and prone position. Results There was no significant differences of the survival rate between thoracoscopic group and thoracotomy group based on pathological stage. 5 year survival without neoadjuvant treatment was 88.9% (pStageI), 71.5%(pStageIIA), 68.1%(pStageIIB), 40.9%(pStageIII), respectively.5 year survival rate of cStageII and III with neoadjuvant chemotherapy was 65.7% and 5 year survival rate of the salvage esophagectomy after failure of definitive chemoradiotherapy was 31.4%. Every outcomes are as good as any reported results in esophagectomy. In the comparison of the lateral position with the prone position, total blood loss was significantly lower in prone position. Inflammatory response after surgery was improved more rapidly in prone group, therefore, prone position is recommended as a minimally invasive procedure for thoracoscopic esophagectomy. Conclusion Thoracoscopic esophagectomy will develop further as a standard operation for esophageal cancer. However, from the point of view of the safety, an appropriate educational systems of this advanced procedure should build. Disclosure All authors have declared no conflicts of interest.

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VS01.04: RELIABLE SURGICAL TECHNIQUES FOR LYMPHADENECTOMY ALONG THE LEFT RECURRENT LARYNGEAL NERVE DURING THORACOSCOPIC ESOPHAGECTOMY IN THE PRONE POSITION

Diseases of the Esophagus ◽

10.1093/dote/doy089.vs01.04 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 44-44

Author(s):

Taro Oshikiri ◽

Tetsu Nakamura ◽

Hiroshi Hasegawa ◽

Masashi Yamamoto ◽

Shingo Kanaji ◽

...

Keyword(s):

Esophageal Cancer ◽

Lymph Node ◽

Lymph Nodes ◽

Recurrent Laryngeal Nerve ◽

Prone Position ◽

Conflicts Of Interest ◽

Surgical Techniques ◽

Laryngeal Nerve ◽

Thoracoscopic Esophagectomy ◽

Left Recurrent Laryngeal Nerve

Abstract Description Background Lymphadenectomy along the left recurrent laryngeal nerve (RLN) in esophageal cancer is important for disease control but requires advanced dissection skills. Complete dissection of the lymph nodes along the left RLN in a safe manner is important. We demonstrate the reliable method for lymphadenectomy along the left RLN during thoracoscopic esophagectomy in the prone position (TEP). Methods This procedure is performed for all of resectable thoracic esophageal cancers. The essence of this method is to recognize the lateral pedicle as a two-dimensional membrane that inclu replicatedes the left RLN, lymph nodes around the nerve, and primary esophageal arteries. By drawing the proximal portion of the divided esophagus and the lateral pedicle, identification and reliable cutting of the primary esophageal arteries and distinguishing the left RLN from the lymph nodes are simplified. Results We performed 46 TEPs for esophageal cancer using this method with no conversion to an open procedure in 2015 at Kobe University. No intraoperative morbidity related to the left RLN was observed. The mean number of harvested lymph nodes along the left RLN was 6.9 ± 4.2. Left RLN palsy greater than Clavien-Dindo classification grade II occurred in 4 patients (8%), all of them were reversible. The incidence of lymph node metastasis along the left RLN was 22%. Conclusion Our method for lymphadenectomy along the left RLN during TEP is safe and reliable. It has a low incidence of left RLN palsy and provides sufficient lymph node dissection along the left RLN. Disclosure All authors have declared no conflicts of interest.

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Low invasiveness of thoracoscopic esophagectomy in the prone position for esophageal cancer: a propensity score-matched comparison of operative approaches between thoracoscopic and open esophagectomy

Surgical Endoscopy ◽

10.1007/s00464-017-5888-z ◽

2017 ◽

Vol 32 (4) ◽

pp. 1945-1953 ◽

Cited By ~ 13

Author(s):

Shinsuke Kanekiyo ◽

Shigeru Takeda ◽

Masahito Tsutsui ◽

Mitsuo Nishiyama ◽

Masahiro Kitahara ◽

...

Keyword(s):

Esophageal Cancer ◽

Propensity Score ◽

Prone Position ◽

Thoracoscopic Esophagectomy ◽

Open Esophagectomy ◽

Matched Comparison

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Outcomes of thoracoscopic esophagectomy in prone position with laparoscopic gastric mobilization for esophageal cancer

Langenbeck s Archives of Surgery ◽

10.1007/s00423-016-1446-8 ◽

2016 ◽

Vol 401 (5) ◽

pp. 699-705 ◽

Cited By ~ 10

Author(s):

Hiroyuki Kitagawa ◽

Tsutomu Namikawa ◽

Masaya Munekage ◽

Kazune Fujisawa ◽

Eri Munekgae ◽

...

Keyword(s):

Esophageal Cancer ◽

Prone Position ◽

Thoracoscopic Esophagectomy

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Changes in respiratory mechanics of artificial pneumothorax two-lung ventilation in video-assisted thoracoscopic esophagectomy in prone position

Scientific Reports ◽

10.1038/s41598-021-86554-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoshinori Tanigawa ◽

Kimihide Nakamura ◽

Tomoko Yamashita ◽

Akira Nakagawachi ◽

Yoshiro Sakaguchi

Keyword(s):

Esophageal Cancer ◽

Prone Position ◽

Respiratory Mechanics ◽

Lung Ventilation ◽

Thoracoscopic Esophagectomy ◽

Secondary Outcome ◽

One Lung Ventilation ◽

Cancer Data ◽

Video Assisted ◽

Artificial Pneumothorax

AbstractWe aimed to clarify the changes in respiratory mechanics and factors associated with them in artificial pneumothorax two-lung ventilation in video-assisted thoracoscopic esophagectomy in the prone position (PP-VATS-E) for esophageal cancer. Data of patients with esophageal cancer, who underwent PP-VATs-E were retrospectively analyzed. Our primary outcome was the change in the respiratory mechanics after intubation (T1), in the prone position (T2), after initiation of the artificial pneumothorax two-lung ventilation (T3), at 1 and 2 h (T4 and T5), in the supine position (T6), and after laparoscopy (T7). The secondary outcome was identifying factors affecting the change in dynamic lung compliance (Cdyn). Sixty-seven patients were included. Cdyn values were significantly lower at T3, T4, and T5 than at T1 (p < 0.001). End-expiratory flow was significantly higher at T4 and T5 than at T1 (p < 0.05). Body mass index and preoperative FEV1.0% were found to significantly influence Cdyn reduction during artificial pneumothorax and two-lung ventilation (OR [95% CI]: 1.29 [1.03–2.24] and 0.20 (0.05–0.44); p = 0.010 and p = 0.034, respectively]. Changes in driving pressure were nonsignificant, and hypoxemia requiring treatment was not noted. This study suggests that in PP-VATs-E, artificial pneumothorax two-lung ventilation is safer for the management of anesthesia than conventional one-lung ventilation (UMIN Registry: 000042174).

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