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Effect of the postural transition in minimally invasive esophagectomy: a propensity score matching analysis

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Abstract

Background

The advantages of prone position in minimally invasive esophagectomy have not been well studied. This study aimed to investigate the safety and feasibility of a transition from the left lateral decubitus position to the prone position for thoracic procedures in minimally invasive esophagectomy.

Methods

We retrospectively analyzed patients with thoracic esophageal carcinomas who underwent thoracoscopic esophagectomy and laparoscopic gastric mobilization between January 2015 and December 2019. The left decubitus and prone positions were analyzed using propensity score-matched pairs for the baseline characteristics, morbidity, and survival.

Results

A total of 114 consecutive patients were included in this study; 90 (78.9%) were male and the median age was 67.2 years old. Of these patients, 39 and 75 underwent left decubitus and prone esophagectomy, respectively. Prone esophagectomy was associated with a lower incidence of pneumonia than that performed in the decubitus position (12.5% vs. 37.5%, p = 0.0187). With respect to the long-term outcomes, there were no significant differences between the 2 groups. The 4-year overall and relapse-free survival rates for prone and decubitus esophagectomy were 73.8% and 73.2%, and 84.4% and 71.8%, respectively (p = 0.9899 and 0.6751, respectively). Prone esophagectomy yielded a shorter operative time (total: 528 [485–579] min vs. 581 [555–610] min, p < 0.0022; thoracic section: 243 [229–271] min vs. 292 [274–309] min, p < 0.0001), less bleeding in the thoracic procedures (0 [0–10] mL vs. 70 [20–138] mL, p < 0.0001), a shorter length of postoperative hospital stay (19 [15–23] vs. 30 [21–46] days, p = 0.0002), and a lower total hospital charge (30,046 [28,175–32,660] US dollars vs. 36,396 [31,533–41,180] US dollars, p < 0.0001).

Conclusions

Transition into the prone position in minimally invasive esophagectomy is feasible with adequate postoperative and oncological safety and economical in esophageal cancer surgery.

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Acknowledgements

The authors would like to thank the Accounting division at The Jikei University Hospital.

Funding

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan

    Yuichiro Tanishima, Katsunori Nishikawa, Yoshitaka Ishikawa, Keita Takahashi, Takahiro Masuda, Takanori Kurogochi, Masami Yuda, Yujiro Tanaka, Akira Matsumoto, Fumiaki Yano, Norio Mitsumori & Toru Ikegami

Authors
  1. Yuichiro Tanishima
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  2. Katsunori Nishikawa
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  3. Yoshitaka Ishikawa
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  6. Takanori Kurogochi
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Contributions

YT: study design, data collection and analysis, and article drafting; KN: data collection and article revision; KT: data collection; YI: data collection; TK: data collection; MY: data collection; YT: data collection; AM: data collection; FY: data collection; NM: data collection; and TI: article revision and final approval.

Corresponding author

Correspondence to Yuichiro Tanishima.

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Disclosures

Drs. Yuichiro Tanishima, Katsunori Nishikawa, Yoshitaka Ishikawa, Keita Takahashi, Takahiro Masuda, Takanori Kurogochi, Masami Yuda, Yujiro Tanaka, Akira Matsumoto, Fumiaki Yano, Norio Mitsumori, and Toru Ikegami have no conflicts of interest or financial ties to disclose.

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Tanishima, Y., Nishikawa, K., Ishikawa, Y. et al. Effect of the postural transition in minimally invasive esophagectomy: a propensity score matching analysis. Surg Endosc 36, 3947–3956 (2022). https://doi.org/10.1007/s00464-021-08714-5

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  • DOI: https://doi.org/10.1007/s00464-021-08714-5

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