title: Minimally invasive esophagectomy: thoracoscopic esophageal mobilization for esophageal cancer with the patient in prone position.
abstract: BACKGROUND
  Surgical resection is the mainstay treatment for resectable esophageal cancer. Minimally invasive esophagectomy is performed with increasing frequency and proves to be a safe and effective surgical alternative to the open technique. Minimally invasive esophagectomy using thoracoscopic esophageal mobilization with the patient in prone position seems to offer some advantages with regard to surgeon ergonomics and clinical outcome.
  
  
  METHODS
  Between July 2005 and September 2010, 46 patients (35 men and 11 women) underwent minimally invasive esophagectomy in the prone position at the authors' institution. Three patients had previously undergone a thoracic intervention (one patient had previously undergone left pneumonectomy because of lung cancer). The preoperative indication was squamous cell carcinoma for 35 patients and adenocarcinoma for 11 patients. In one case, the histology of the biopsy samples showed a squamous cell carcinoma with neuroendocrine differentiation. Neoadjuvant treatment was administered to 15 patients.
  
  
  RESULTS
  All 46 patients underwent esophagectomy using minimally invasive thoracic mobilization of the esophagus with the patient in prone position. The abdominal stage of intervention was performed by laparoscopy for 37 patients and by laparotomy for 9 patients. No thoracotomic conversion was performed. In all cases, a cervical end-to-side anastomosis was performed using a circular stapler. The mean operative time was 263 min. The median intensive care unit stay was 2 days, and the median postoperative hospital stay was 15 days. The mean number of procured lymph nodes was 13. The perioperative morbidity rate was 37%, and the perioperative mortality rate was 4.4%.
  
  
  CONCLUSIONS
  Minimally invasive esophagectomy is safe and technically feasible. It entails a lower mortality rate and a shorter hospital stay than those reported in most open series. Thoracoscopy with the patient in prone position offers results comparable with those obtained using other minimally invasive techniques regarding the number of procured lymph nodes. This technique shows considerable advantages such as improved surgeon ergonomics, increased operative field exposure, and satisfactory respiratory results.
authors: Department of General Surgery, Azienda Ospedaliero-Universitaria of Udine Santa Maria della Misericordia, Piazzale Santa Maria della Misericordia, 15, 33100, Udine, Italy. petri.roberto@aoud.sanita.fvg.it
authors: Roberto
authors: R
authors: Petri
authors: Marco
authors: M
authors: Zuccolo
authors: Marco
authors: M
authors: Brizzolari
authors: Luca
authors: L
authors: Rossit
authors: Alessandro
authors: A
authors: Rosignoli
authors: Vittorio
authors: V
authors: Durastante
authors: Gianfranco
authors: G
authors: Petrin
authors: Lucio
authors: L
authors: De Cecchis
authors: Mario
authors: M
authors: Sorrentino
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D003422:Critical Care / Q000706:statistics & numerical data; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011183:Postoperative Complications / Q000209:etiology; D016684:Prone Position; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*