title: Lateral position could provide more excellent hemodynamic parameters during video-assisted thoracoscopic esophagectomy for cancer.
abstract: BACKGROUND
  Thoracoscopic esophagectomy is a feasible technique that has been shown to be safe for the treatment of esophageal cancer. There continues to be controversy about the optimal position during thoracoscopic esophagectomy. In this study, we compared the intraoperative hemodynamic parameters, clinical pathological characteristics, as well as postoperative complications in patients who underwent thoracoscopic esophagectomy in the prone position (PP) or left-lateral decubitus position (LDP).
  
  
  METHODS
  Between January 2011 and June 2011, 23 patients underwent thoracoscopic esophagectomies for cancer of the esophagus in LDP (group A). Since February 2011, we have performed thoracoscopic esophagectomies for cancer of the esophagus in PP for 21 patients (group B). The demographics and clinicopathologic factors, as well as the intraoperative hemodynamic parameters, of the two groups were analyzed.
  
  
  RESULTS
  No postoperative death occurred in these 44 patients. Overall morbidity was similar in the two groups. No significant difference in the length of operation or number of retrieved mediastinal nodes between the two groups was observed, but the intraoperative blood loss in group A was significantly higher than in group B (P = 0.0228). There was no significant difference of the intraoperative mean arterial pressure, central venous pressure, heart rate, and stroke volume variation between the two groups and various positions. In group A, the cardiac output (CO), cardiac index (CI), as well as stroke volume index (SVI) did not exhibit significant difference after altering patients' position from LDP to SP. However, patients who underwent thorascopic esophagectomy in PP had lower CO, CI, and SVI than in LDP during the thoracoscopic stage.
  
  
  CONCLUSIONS
  Compared with the PP, the LDP could provide more excellent hemodynamic parameters during thoracoscopic esophagectomy. However, the various hemodynamic statuses did not exert significant influence on the occurrence of postoperative complications.
authors.affiliation: Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China.
authors.forename: Ying-Bo
authors.initials: YB
authors.lastname: Zou
authors.forename: Hong
authors.initials: H
authors.lastname: Yan
authors.forename: Xue-Hai
authors.initials: XH
authors.lastname: Liu
authors.forename: Yin-Jie
authors.initials: YJ
authors.lastname: Zhao
authors.forename: Yao-Guang
authors.initials: YG
authors.lastname: Jiang
authors.forename: Ru-Wen
authors.initials: RW
authors.lastname: Wang
authors.forename: Wei
authors.initials: W
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology; D001145:Arrhythmias, Cardiac / Q000209:etiology; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D061646:Operative Time; D056888:Patient Positioning / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000209:etiology