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Open Access 01-06-2018

Minimally invasive esophagectomy: a propensity score-matched analysis of semiprone versus prone position

Authors: Maarten F. J. Seesing, Lucas Goense, Jelle P. Ruurda, Misha D. P. Luyer, Grard A. P. Nieuwenhuijzen, Richard van Hillegersberg

Published in: Surgical Endoscopy | Issue 6/2018

Abstract

Background

The preferred surgical approach for esophageal cancer is a minimally invasive transthoracic esophagectomy with a two-field lymph node dissection. The thoracoscopic phase may be performed either in prone- or in left lateral decubitus (LLD) position. Prone positioning has been associated with better pulmonary outcomes compared to LLD positioning; however, conversion to a classic thoracotomy is more difficult. The semiprone position has been proposed as an alternative approach.

Methods

A retrospective review of a prospectively maintained database (2008–2014) was performed to compare postoperative complications, surgical radicality, and lymph node yield between patients who underwent three-stage minimally invasive transthoracic esophagectomy in either the prone or semiprone position. Comparative analyses were conducted before and after propensity score matching.

Results

One hundred and twenty-one patients were included. In total, 82 patients underwent minimally invasive esophagectomy (MIE) in semiprone position and 39 patients in prone position. After propensity score matching, both groups consisted of 39 patients. The operative time in the semiprone group was longer (368 vs. 225 min, P < 0.001) and in this group the lymph node yield was significantly higher (16 (range 6–80) vs. 13 (range 3–33), P = 0.019). There were no statistically significant differences regarding radical resections, postoperative complications, and hospital stay.

Conclusion

The use of semiprone positioning in MIE is safe, feasible, and at least comparable to MIE in prone position in terms of oncological clearance and postoperative complications.

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Title: Minimally invasive esophagectomy: a propensity score-matched analysis of semiprone versus prone position
Authors: Maarten F. J. Seesing
Lucas Goense
Jelle P. Ruurda
Misha D. P. Luyer
Grard A. P. Nieuwenhuijzen
Richard van Hillegersberg
Publication date: 01-06-2018
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 6/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-017-5975-1

At a glance: The STEP trials

Springer Medicine

Minimally invasive esophagectomy: a propensity score-matched analysis of semiprone versus prone position

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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