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Long-Term Outcomes of Thoracoscopic Esophagectomy in the Prone versus Lateral Position: A Propensity Score-Matched Analysis

  • Thoracic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Several studies have suggested that thoracoscopic esophagectomy (TE) in the prone position (TEP) may be more feasible than TE in the lateral position (TEL); however, few studies have compared long-term survival between the two procedures. We evaluated whether TEP is oncologically equivalent to TEL.

Methods

Surgical outcomes of TEs performed from January 2006 to December 2013 at our hospital were retrospectively analyzed. Propensity score matching was used to control for confounding factors.

Results

TE was performed in 200 patients diagnosed with esophageal squamous cell carcinoma; 78 patients were matched in two procedures. The mean thoracic operative time in TEL was shorter than in TEP (228.9 min vs. 299.1 min; p < 0.001); however, the mean thoracic blood loss in TEL was higher than in TEP (186.9 ml vs. 76.5 ml; p < 0.001). The mean number of thoracic lymph nodes harvested in TEL was lower than in TEP (23.5 vs. 26.9; p < 0.05), and the pulmonary complication rate in TEL was higher than in TEP (30.8% vs. 15.4%; p < 0.05). The 5-year overall survival rates in pathological stage I (81.2% vs. 81.6%; p = 0.82), stage II (65.3% vs. 80.9%; p = 0.21), stage III (26.7% vs. 24.2%; p = 0.86) and all stages (63.6% vs. 62.3%; p = 0.88), and the 5-year progression-free survival rates in pathological stage I (78.0% vs. 81.8%; p = 0.54), stage II (53.5% vs. 77.6%; p = 0.13), stage III (10.5% vs. 12.8%; p = 0.81) and all stages (53.6% vs. 57.9%; p = 0.50) were not significantly different between the two procedures.

Conclusion

TEP and TEL provide equal oncological efficiency.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Susumu Miura MD, Tetsu Nakamura PhD, MD, Yukiko Miura MD, Gosuke Takiguchi PhD, MD, Nobuhisa Takase PhD, MD, Hiroshi Hasegawa PhD, MD, Masashi Yamamoto PhD, MD, Shingo Kanaji PhD, MD, Yoshiko Matsuda PhD, MD, Kimihiro Yamashita PhD, MD, Taro Oshikiri PhD, MD & Yoshihiro Kakeji PhD, MD

  2. Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Takeru Matsuda PhD, MD

  3. Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan

    Satoshi Suzuki PhD, MD

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  1. Susumu Miura MD
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Correspondence to Susumu Miura MD.

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Susumu Miura, Tetsu Nakamura, Yukiko Miura, Gosuke Takiguchi, Nobuhisa Takase, Hiroshi Hasegawa, Masashi Yamamoto, Shingo Kanaji, Yoshiko Matsuda, Kimihiro Yamashita, Takeru Matsuda, Taro Oshikiri, Satoshi Suzuki, and Yoshihiro Kakeji have no commercial interests in the study subject to disclose.

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Miura, S., Nakamura, T., Miura, Y. et al. Long-Term Outcomes of Thoracoscopic Esophagectomy in the Prone versus Lateral Position: A Propensity Score-Matched Analysis. Ann Surg Oncol 26, 3736–3744 (2019). https://doi.org/10.1245/s10434-019-07619-x

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