Esophageal Position Affects Short-Term Outcomes After Minimally Invasive Esophagectomy: A Retrospective Multicenter Study

  • Tomoyuki Uchihara
  • Naoya Yoshida
  • Yoshifumi Baba
  • Yuichiro Nakashima
  • Yasue Kimura
  • Hiroshi Saeki
  • Shinsuke Takeno
  • Noriaki Sadanaga
  • Masahiko Ikebe
  • Masaru Morita
  • Yasushi Toh
  • Atsushi Nanashima
  • Yoshihiko Maehara
  • Hideo BabaEmail author
Original Scientific Report



Anatomical esophageal position may affect the short-term outcomes after minimally invasive esophagectomy (MIE). A previous single-institutional retrospective study suggested that the presence of a left-sided esophagus (LSE) made MIE more difficult and increased the incidence of postoperative complications.


The current study was a multicenter retrospective study of 303 patients with esophageal cancer who underwent MIE at six esophageal cancer high-volume centers in Kyushu, Japan, between April 2011 and August 2016. The patients were divided into the LSE (66 patients) and non-LSE groups (237 patients) based on the esophageal position on computed tomography images obtained with the patients in the supine position.


Univariate analysis showed that patients with LSE were significantly older than those with non-LSE (69 ± 8 vs. 65 ± 9 years; P = 0.002), had a significantly greater incidence of cardiovascular comorbidity (65.2% vs. 47.7%; P = 0.013), and a significantly longer operating time (612 ± 112 vs. 579 ± 102 min; P = 0.025). Logistic regression analysis verified that LSE was an independent risk factor for the incidence of pneumonia (odds ratio 3.3, 95% confidence interval 1.254–8.695; P = 0.016).


The presence of a LSE can increase the procedural difficulty of MIE and the incidence of morbidity after MIE. Thus, careful attention must be paid to anatomical esophageal position before performing MIE.



We thank Kelly Zammit, BVSc, and Cathel Kerr, PhD, from Edanz Group ( for editing a draft of this manuscript.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

268_2019_5273_MOESM1_ESM.docx (23 kb)
Supplementary material 1 (DOCX 22 kb)


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Tomoyuki Uchihara
    • 1
  • Naoya Yoshida
    • 1
  • Yoshifumi Baba
    • 1
  • Yuichiro Nakashima
    • 2
  • Yasue Kimura
    • 3
  • Hiroshi Saeki
    • 2
  • Shinsuke Takeno
    • 6
  • Noriaki Sadanaga
    • 4
  • Masahiko Ikebe
    • 5
  • Masaru Morita
    • 5
  • Yasushi Toh
    • 5
  • Atsushi Nanashima
    • 6
  • Yoshihiko Maehara
    • 2
  • Hideo Baba
    • 1
    Email author
  1. 1.Department of Gastroenterological Surgery, Graduate School of Medical SciencesKumamoto UniversityKumamotoJapan
  2. 2.Department of Surgery and Science, Graduate School of Medical SciencesKyushu UniversityFukuokaJapan
  3. 3.Department of SurgeryIizuka HosipitalFukuokaJapan
  4. 4.Department of SurgerySaiseikai Fukuoka General HospitalFukuokaJapan
  5. 5.Department of Gastroenterological SurgeryNational Hospital Organization, Kyushu Cancer CenterFukuokaJapan
  6. 6.Division of Gastrointestinal-Endocrine-Pediatric Surgery, Department of Surgery, Faculty of MedicineUniversity of MiyazakiMiyazakiJapan

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