Advantages of the prone position for minimally invasive esophagectomy in comparison to the left decubitus position: better oxygenation after minimally invasive esophagectomy.
OBJECTIVE
The aim of this retrospective study was to evaluate whether minimally invasive esophagectomy (MIE) in the prone position has advantages over the left decubitus position.


METHODS
A total of 110 consecutive patients with esophageal cancer who had undergone MIE were included in the analysis. The clinical outcomes were compared between 51 patients treated in the prone position (prone group) and 59 patients treated in the left decubitus position (LD group). The main outcome was postoperative respiratory complications and postoperative oxygenation [arterial oxygen pressure/fraction of inspired oxygen (P/F ratio)]. The secondary outcomes included the length of the operation, blood loss, number of dissected lymph nodes, postoperative morbidities and mortality.


RESULTS
The P/F ratio after the operation was significantly higher in the prone group (0 h: P = 0.01, 12 h: P < 0.001). No significant differences were observed in the frequency of respiratory complications (P = 0.89). The blood loss in the prone group was significantly lower (P < 0.001), and the number of dissected intrathoracic lymph nodes was significantly higher (P = 0.03) than in the LD group. No significant differences were observed in the frequencies of overall postoperative complications.


CONCLUSIONS
MIE in the prone position preserves better oxygenation of patients during the early recovery period, and is associated with less blood loss and a larger number of dissected lymph nodes.
Department of Surgery, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-Ku, Kyoto, 606-8507, Japan, tanaei@kuhp.kyoto-u.ac.jp.
Eiji
E
Tanaka
Hiroshi
H
Okabe
Yousuke
Y
Kinjo
Shigeru
S
Tsunoda
Kazutaka
K
Obama
Shigeo
S
Hisamori
Yoshiharu
Y
Sakai
D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood*; D056888:Patient Positioning / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D016684:Prone Position; D012131:Respiratory Insufficiency / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome
D015415:Biomarkers; D010100:Oxygen