Thoracoscopy in prone position with two-lung ventilation compared to conventional thoracotomy during Ivor Lewis procedure: a multicenter case–control study

Abstract

Background

Intraoperative management based on thoracoscopy, prone position and two-lung ventilation could decrease the rate of postoperative pulmonary complications after esophagectomy. The aim of this study was to compare this multifaceted approach (MIE-PP) and conventional thoracotomy for Ivor Lewis procedure after a systematic laparoscopic dissection.

Methods

Data from 137 consecutive patients undergoing Ivor Lewis procedures between 2010 and 2017 at two tertiary centers was analyzed retrospectively. The outcomes of patients who underwent MIE-PP (n = 58; surgeons group 1) were compared with those of patients undergoing conventional approach (n = 79; surgeons group 2). Our primary outcome was major postoperative pulmonary complications. Our main secondary outcomes were anastomotic leak, quality of resection and mortality.

Results

Female patients were more prevalent in the MIE-PP group (p = 0.002). Other patient characteristics, cTNM staging and neoadjuvant treatment rate were not different between groups. Major postoperative pulmonary complications were significantly lower in the MIE-PP group compared to Conventional group (24 vs. 44%; p = 0.014). Anastomotic leak occurred in 31 versus 18% in MIE-PP group and Conventional groups, respectively (p = 0.103). Complete resection rate (98 vs. 95%; p = 0.303) and mean number of harvested lymph nodes (16 (4–40) vs. 18 (3–37); p = 0.072) were similar between the two groups. Postoperative mortality rates were 0 versus 2% at day 30 (p = 0.508) and 0 versus 7.6% at day 90 (p = 0.038).

Conclusion

Short-term outcomes of minimally invasive Ivor Lewis using thoracoscopy, prone position and two-lung ventilation are at least equivalent to the hybrid approach. Anastomotic leak after MIE-PP remains a major concern.

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Acknowledgements

We thank the University of Montpellier and the University of Rouen for their support. We thank the surgeons Paul Martre, Lilian Schwarz, Thibaut Coste, Eric Bouley, Francoise Guillon, John Chauvat and Yvan Pouzeratte, Marie Genies, Bruno Souche, Audrey De Jong (reanimators) for their advice regarding the pulmonary complication analysis. We are grateful to Sarah Kabani for editorial assistance and Dr Jacqueline Butterworth for proofreading of the manuscript. We thank the residents, fellows, and nurses of our division for the care they provided to these patients. The authors have no source of funding to disclose for this study.

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Correspondence to R. Souche.

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R. Souche, M. Nayeri, R. Chati, E. Huet, I. Donici, J. J. Tuech, F. Borie, M. Prudhomme, S. Jaber and J. M. Fabre have no conflicts of interest or financial ties to disclose.

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Souche, R., Nayeri, M., Chati, R. et al. Thoracoscopy in prone position with two-lung ventilation compared to conventional thoracotomy during Ivor Lewis procedure: a multicenter case–control study. Surg Endosc 34, 142–152 (2020). https://doi.org/10.1007/s00464-019-06742-w

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Keywords

  • Esophageal cancer
  • Prone position
  • Minimally invasive
  • Ivor Lewis
  • Pulmonary complications