title: Comparison of the short-term postoperative results of prone positioning and lateral decubitus positioning during thoracoscopic esophagectomy.
abstract: BACKGROUND
  The conventional approach during thoracoscopic esophagectomy was performed in the left lateral decubitus position (LLDP). Recently, thoracoscopic esophagectomy in the prone position (PP) has attracted the attention of surgeons.
  
  
  OBJECTIVE
  To report institutional experience with thoracoscopic esophagectomy in PP and compare it with the conventional LLDP approach.
  
  
  METHODS
  We reviewed 59 consecutive patients who had presented with esophageal cancer undergoing three-stage thoracoscopic/laparoscopic esophagectomy (TLE) from May 2011 to Dec 2013. The TLE was sequentially performed on enrolled patients in LLDP from May 2011 to Oct 2012 and in PP from Nov 2012 to Dec 2013. Immediate postoperative outcomes were collected and compared to determine differences between the 2 groups.
  
  
  RESULTS
  Thirty-eight patients had their operations in LLDP and 21 in PP. No differences in blood loss, respiratory condition during surgery, or postoperative pain scores were observed between the 2 groups. The PP had a shorter thoracic stage duration (3.4 vs. 3.9 h; p = 0.03) and shorter intensive care unit (ICU) stay (1.0 vs. 1.5 days; p = 0.03) but yielded a similar number of lymph nodes. Incidence of complications was similar between the 2 groups, except significantly lower incidence of pneumonia in PP (0% vs. 21.1%; p = 0.04) and higher incidence of hoarseness in PP (52.4% vs. 23.7%; p = 0.03). The symptoms resolved within 3 months in all patients except in the 2 patients with vocal cord palsy.
  
  
  CONCLUSIONS
  It is feasible and safe to perform thoracoscopic esophagectomy by adopting the prone position. Thoracoscopic esophagectomy in the prone position is potentially associated with fewer major complications and shorter ICU stay.
authors.affiliation: Department of Anesthesiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Nai Liang
authors.initials: NL
authors.lastname: Li
authors.affiliation: Department of Anesthesiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Wen-Ling
authors.initials: WL
authors.lastname: Peng
authors.affiliation: Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chia-Chuan
authors.initials: CC
authors.lastname: Liu
authors.affiliation: Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
authors.forename: Chih-Hsun
authors.initials: CH
authors.lastname: Shih
keywords: esophageal cancer; minimally invasive esophagectomy; prone position; thoracoscopic esophagectomy