title: Thoracolaparoscopic esophagectomy: is the prone position a safe alternative to the decubitus position?
abstract: BACKGROUND
  During the last few years, prone thoracoscopic esophagectomy has been increasingly adopted for thoracolaparoscopic esophagectomy (TLE). However, evidence for the prone position (PP) over the decubitus position (DP) during TLE is currently not strong enough to reach conclusions.
  
  
  METHODS
  From May 2009 to December 2010, we conducted thoracoscopic esophagectomies in the DP and then PP on consecutive patients admitted to our institution. TLE in DP was conducted from May 2009 to February 2010 and in PP from March 2010 to December 2010. Clinical features and operation characteristics of all patients were collected and compared to determine differences between the 2 groups.
  
  
  RESULTS
  A total of 93 consecutive esophageal cancer patients were enrolled; Forty-one had their operations in DP and 52 in PP. There was no significant difference found between the 2 groups in age, sex, body mass index, tumor location, histological type, and TNM stage. When compared with DP, thoracoscopic esophagectomy in PP had a shorter operation duration (67 vs 77 minutes; p = 0.013), horter overall hospital stay (17.4 vs 11.4 days; p = 0.011), and yielded a larger number of lymph nodes (11.6 ± 4.0 vs 8.9 ± 4.9 on average; p = 0.005). Complication rates were similar between the 2 groups, with anastomotic leak developing in a significantly smaller number of patients in PP (7.7% vs 22.0%; p = 0.049).
  
  
  CONCLUSIONS
  TLE in the PP is a feasible and safe alternative to DP and is potentially associated with fewer complications. Additional randomized studies are required to discuss the long-term prognostic value of this procedure.
authors.affiliation: Division of Thoracic Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
authors.forename: Mingxiang
authors.initials: M
authors.lastname: Feng
authors.forename: Yaxing
authors.initials: Y
authors.lastname: Shen
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.forename: Lijie
authors.initials: L
authors.lastname: Tan
authors.forename: Yi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Muhammad Asim
authors.initials: MA
authors.lastname: Khan
authors.forename: Qun
authors.initials: Q
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000209:etiology; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016684:Prone Position; D013530:Surgical Wound Infection / Q000209:etiology