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Comparison of perioperative and oncological outcome of thoracoscopic esophagectomy in left decubitus position and in prone position for esophageal cancer

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Abstract

Purpose

The aim of this study was to clarify the differences between thoracoscopic esophagectomy in the left decubitus position (LP) and in the prone position (PP) in terms of short-term perioperative outcomes and long-term oncological outcomes after more than 5 years of follow-up.

Methods

Patients with esophageal cancer who underwent thoracoscopic esophagectomy and were followed up for more than 5 years were analyzed retrospectively. Of 142 patients, 72 underwent LP esophagectomy and 70 underwent PP esophagectomy. Operation time, blood loss, operative morbidity, mortality, length of hospital stay, and the number of dissected lymph nodes were compared to evaluate short-term outcomes. Cancer recurrence and overall survival were compared to examine long-term outcomes.

Results

Patient and tumor characteristics were not different between the LP and PP groups except for the rate of neoadjuvant chemotherapy. Blood loss was significantly lower in the PP group than in the LP group. Incidence of Clavien-Dindo (C.D.) grade ≥ III complications was significantly lower in the PP group than in the LP group. Pulmonary complications were also significantly lower in the PP group than in the LP group. Operation type (LP versus PP) was identified as an independent risk factor for pulmonary complications (odds ratio 0.27, p = 0.03) by multivariate analysis. Cancer recurrence rate, initial recurrence site, and overall survival rate were not different between the two groups.

Conclusions

PP is regarded as a less invasive procedure than LP with the same oncological effect.

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Authors and Affiliations

  1. Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata Prefecture, 950-1197, Japan

    Shirou Kuwabara, Kazuaki Kobayashi, Akira Kubota, Ikuma Shioi, Kenji Yamaguchi & Norio Katayanagi

Authors
  1. Shirou Kuwabara
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  2. Kazuaki Kobayashi
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  3. Akira Kubota
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  4. Ikuma Shioi
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  5. Kenji Yamaguchi
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  6. Norio Katayanagi
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Contributions

SK contributed to the study design, analysis, and interpretation of data and writing of the manuscript. KK and IS participated in the acquisition and analysis of data. AK and KY contributed to the analysis and interpretation of data. NK participated in the study conception and critical review.

Corresponding author

Correspondence to Shirou Kuwabara.

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The authors declare that they have no conflict of interest.

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For this type of study, formal consent is not required.

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Kuwabara, S., Kobayashi, K., Kubota, A. et al. Comparison of perioperative and oncological outcome of thoracoscopic esophagectomy in left decubitus position and in prone position for esophageal cancer. Langenbecks Arch Surg 403, 607–614 (2018). https://doi.org/10.1007/s00423-018-1674-1

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  • DOI: https://doi.org/10.1007/s00423-018-1674-1

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