Technical and perioperative outcomes of minimally invasive esophagectomy in the prone position

Ross F. Goldberg, Steven P. Bowers, Michael Parker, John A. Stauffer, Horacio J. Asbun, C. Daniel Smith

Research output: Contribution to journalArticle

13 Scopus citations

Abstract

Background: Minimally invasive esophagectomy (MIE) is performed through various approaches, including using video-assisted thoracoscopic surgery for mediastinal esophageal dissection. The prone technique allows for gravity-aided retraction of the lung. The aim of this study was to examine perioperative outcomes after prone MIE in relation to patient preoperative comorbidities. Methods: A retrospective cohort study from our single tertiary-care center is presented. Between January 2007 and August 2010, a total of 42 patients underwent three-field prone MIE. The majority of patients were male (37 vs. 5 female), with an average age of 68 years (range = 37-87). The diagnoses for patients who underwent MIE were 35 adenocarcinoma, four Barrett's esophagus with high-grade dysplasia, two achalasia, and one squamous cell carcinoma. Neoadjuvant chemotherapy with or without radiotherapy was administered to 16 (38 %) patients. Preoperative comorbidities were quantified using the Modified Charlson Comorbidity Index; low risk was defined as a score of 0-2 (23 patients), moderate risk 3-4 (14 patients), and high risk 5 or higher (five patients). Postoperative complications were stratified using the Clavien Classification Scale; minor complications were grades 1 and 2 and major complications were grades 3-5. Results: Median length of hospital stay was 8 days (range = 6-51) and median ICU stay was 2 days (range = 1-26). Average prone surgical time was 108 min (range = 67-198). Thirty-seven of 42 patients (88 %) were extubated on the day of operation. Postoperatively, all five high-risk patients had a complication, three of which were major. Eight of the 14 moderate-risk patients had a complication and three were major, and 17 of the 23 low-risk group had a complication with nine being major. There was a total of 15 major complications. Predominant complications were arrhythmias (15) and pneumonia (five), with four anastomotic leaks and two postoperative 30-day mortalities. Conclusions: This series supports using prone MIE. Despite a clinical pathway, including immediate extubation postoperatively, there is still a risk of pulmonary complications that appears to correlate with higher preoperative comorbidity scores.

Original languageEnglish (US)
Pages (from-to)553-557
Number of pages5
JournalSurgical endoscopy
Volume27
Issue number2
DOIs
StatePublished - Feb 2013

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Keywords

  • Esophageal cancer
  • Esophagectomy
  • Minimally invasive esophagectomy

ASJC Scopus subject areas

  • Surgery

Cite this

Goldberg, R. F., Bowers, S. P., Parker, M., Stauffer, J. A., Asbun, H. J., & Smith, C. D. (2013). Technical and perioperative outcomes of minimally invasive esophagectomy in the prone position. Surgical endoscopy, 27(2), 553-557. https://doi.org/10.1007/s00464-012-2479-x