Minimally invasive esophagectomy in the lateral‐prone position: Experience of 124 cases in a single center

Abstract

BackgroundMinimally invasive esophagectomy was first introduced as a new technique for esophageal cancer treatment 20 years ago. Performing this procedure in the lateral‐prone position is the most appropriate method. Since May 2013, our center has performed 124 esophageal cancer operations using this procedure. Herein, we share our experience.MethodsWe retrospectively reviewed 124 consecutive patients who had received minimally invasive esophagectomy in the lateral‐prone position from May 2013 to June 2017. The procedure, operative variables, postoperative complications, and oncology outcomes were assessed.ResultsThe surgery was successful in all 124 patients; three cases converted to an abdominal opening procedure during surgery. The mean total lymph node harvest was 19.2: 12.9 in the thoracic cavity and 6.0 in the abdominal cavity. The average total operation duration was 376 minutes and blood loss was 156 mL. No mortality occurred within 30 postoperative days. Forty‐three cases of postoperative morbidity occurred in 38 patients (30.6%), including 11 anastomotic leakages (8.9%), 1 chyle leak (0.8%), 12 lateral recurrent nerve palsies (9.7%), 11 pulmonary complications (8.9%), and 8 other complications (6.5%). A learning curve indicated that blood loss, operation duration, and the number of lymph nodes harvested would improve with time.ConclusionsSurgical and oncological outcomes following minimally invasive esophagectomy for esophageal cancer were acceptable. There are some advantages to this technique compared to previous reports of opening procedures.

Clinical analysis of minimally invasive McKeown esophagectomy in a single center by a single medical group

“…All 82 esophagectomy cases were performed successfully with the MIME procedure. Operative time was 260 min and blood loss was 100 ml, which were similar to the results in other studies (Meng et al, 2014;Ma et al, 2018). A previous study reported that blood loss during MIE was less than that during OE, but the operative time was not shorter than that in OE (Lv et al, 2016).…”

“…In our 82 cases, the total complication rate was 24.4%, which was much lower than previously reported for open esophagectomy (OE) (Low et al, 2015) and MIE (Ma et al, 2018). Anastomotic leakage was the major complication of esophagectomy, and occurred in 4.9% of our cases.…”

Learning curve and postoperative outcomes of minimally invasive esophagectomy

“…Most reports have used intraoperative variables, such as operative time (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), but other reports have also used clinically more relevant outcome parameters, such as postoperative complications and anastomotic leakage (13,14,19). Regarding analysis methods, most studies assigned patients to arbitrarily created groups and compared outcomes of patients operated on early after implementation between patients operated on later (9,11,(20)(21)(22)(23)(24)(25)(26)(27). Other studies used cumulative sum (CUSUM) analysis or variations of CUSUM and therefore omitted splitting a patient population in arbitrarily created groups (6,8,10,11,14,16,18,19).…”

Eventos adversos durante la esofagectomía mininvasiva en posición prona y su relación con la curva de aprendizaje

“…This could be due to the small sample size. For some authors, the learning curve to reach a plateau ranges between 15 and 20 cases, while other authors who worked with systematized cumulative measurement systems reported > 35 or 40 cases 8,[27][28][29][30][31] .…”

“…Esto podría deberse al tamaño reducido de la muestra. Para algunos autores, los casos necesarios para alcanzar la meseta en la curva de aprendizaje oscilan entre 15 y 20; para otros, que trabajaron con sistemas de mediciones acumulativos y sistematizados, el número debe ser mayor de 35 o 40 8,[27][28][29][30][31] .…”