Background

The advantages of prone position in minimally invasive esophagectomy have not been well studied. This study aimed to investigate the safety and feasibility of a transition from the left lateral decubitus position to the prone position for thoracic procedures in minimally invasive esophagectomy.

Methods

We retrospectively analyzed patients with thoracic esophageal carcinomas who underwent thoracoscopic esophagectomy and laparoscopic gastric mobilization between January 2015 and December 2019. The left decubitus and prone positions were analyzed using propensity score-matched pairs for the baseline characteristics, morbidity, and survival.

Results

A total of 114 consecutive patients were included in this study; 90 (78.9%) were male and the median age was 67.2 years old. Of these patients, 39 and 75 underwent left decubitus and prone esophagectomy, respectively. Prone esophagectomy was associated with a lower incidence of pneumonia than that performed in the decubitus position (12.5% vs. 37.5%, p = 0.0187). With respect to the long-term outcomes, there were no significant differences between the 2 groups. The 4-year overall and relapse-free survival rates for prone and decubitus esophagectomy were 73.8% and 73.2%, and 84.4% and 71.8%, respectively (p = 0.9899 and 0.6751, respectively). Prone esophagectomy yielded a shorter operative time (total: 528 [485–579] min vs. 581 [555–610] min, p < 0.0022; thoracic section: 243 [229–271] min vs. 292 [274–309] min, p < 0.0001), less bleeding in the thoracic procedures (0 [0–10] mL vs. 70 [20–138] mL, p < 0.0001), a shorter length of postoperative hospital stay (19 [15–23] vs. 30 [21–46] days, p = 0.0002), and a lower total hospital charge (30,046 [28,175–32,660] US dollars vs. 36,396 [31,533–41,180] US dollars, p < 0.0001).

Conclusions

Transition into the prone position in minimally invasive esophagectomy is feasible with adequate postoperative and oncological safety and economical in esophageal cancer surgery.

中文翻译：

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微创食管切除术中体位转换的影响：倾向评分匹配分析

背景

俯卧位在微创食管切除术中的优势尚未得到很好的研究。本研究旨在探讨在微创食管切除术中从左侧卧位过渡到俯卧位的胸部手术的安全性和可行性。

方法

我们回顾性分析了 2015 年 1 月至 2019 年 12 月期间接受胸腔镜食管切除术和腹腔镜胃动员的胸段食管癌患者。使用倾向评分匹配对分析左侧卧位和俯卧位的基线特征、发病率和生存率。

结果

本研究共纳入 114 名连续患者；90 人（78.9%）为男性，中位年龄为 67.2 岁。在这些患者中，分别有 39 名和 75 名接受了左侧褥疮和俯卧食管切除术。与卧位相比，俯卧位食管切除术与较低的肺炎发生率相关（12.5% vs. 37.5%，p  = 0.0187）。就长期结果而言，两组之间没有显着差异。俯卧位和卧位食管切除术的 4 年总生存率和无复发生存率分别为 73.8% 和 73.2%，以及 84.4% 和 71.8%（分别为p  = 0.9899 和 0.6751）。俯卧位食管切除术的手术时间更短（总计：528 [485–579] 分钟 vs. 581 [555–610] 分钟，p < 0.0022; 胸段：243 [229–271] 分钟 vs. 292 [274–309] 分钟，p  < 0.0001)，胸腔手术出血更少（0 [0–10] mL vs. 70 [20–138] mL，p  < 0.0001），术后住院时间更短（19 [15-23] 对 30 [21-46] 天，p  = 0.0002），总住院费用更低（30,046 [28,175-32,660] 美元对36,396 [31,533–41,180] 美元，p  < 0.0001）。

结论

在微创食管切除术中过渡到俯卧位是可行的，具有足够的术后和肿瘤学安全性，并且在食管癌手术中是经济的。