title: Minimally invasive esophagectomy performed with the patient in a prone position: a systematic review.
abstract: OBJECTIVE
  We reviewed the surgical results of minimally invasive esophagectomy for esophageal cancer, performed with the patient in a prone position (MIE-PP), to assess its benefits.
  
  
  METHODS
  A systematic literature search was performed, and articles that fully described the surgical results of MIE-PP were selected. Parameters such as operative time, blood loss, and postoperative outcomes were compared with those obtained for open transthoracic esophagectomy (OE) and minimally invasive esophagectomy in a lateral decubitus position (MIE-LP).
  
  
  RESULTS
  The conversion rate from MIE-PP to open surgery was very low. MIE-PP was associated with longer operative time and lower blood loss than OE. Although studies from a single institution did not show an apparent difference in morbidity or mortality among the three operative groups, results of a multicenter randomized controlled trial showed a reduction in pulmonary infection and recurrent laryngeal nerve palsy in MIE-PP, compared with OE. The benefits of MIE-PP vs. those of MIE-LP remain controversial.
  
  
  CONCLUSIONS
  Theoretically, the operative results of MIE-PP might be better than those of MIE-LP for patients with esophageal cancer; however, studies have not yet verified this. Further clinical studies are required to establish whether the advantages of MIE-PP can be translated into clinical outcome.
authors: Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. kkoyanag@ncc.go.jp.
authors: Kazuo
authors: K
authors: Koyanagi
authors: Department of Gastroenterological Surgery, Tokai University School of Medicine, Isehara, Japan.
authors: Soji
authors: S
authors: Ozawa
authors: Esophageal Surgery Division, Department of Gastrointestinal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
authors: Yuji
authors: Y
authors: Tachimori
mesh_terms: D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D005240:Feasibility Studies; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D016684:Prone Position; D016896:Treatment Outcome
keywords: Esophageal cancer; Minimally invasive; Prone position