title: Effect of Esophagus Position on Surgical Difficulty and Postoperative Morbidities After Thoracoscopic Esophagectomy.
abstract: The objective include thoracoscopic esophagectomy for the deep-seated (left-sided) esophagus has several technical difficulties, which may affects the intraoperative or postoperative outcomes. However, no previous studies have focused on the correlation between the position of the esophagus and short-term outcome after thoracoscopic esophagectomy. Of 470 esophagectomies between April 2005 and April 2015 in Kumamoto University Hospital, 112 patients who underwent thoracoscopic esophagectomy for esophageal cancer were examined. The position of the esophagus was divided into 2 types: deep-seated esophagus or another type based on computed tomographic images in the supine position. In results, the deep-seated esophagus was associated with a longer operation time in the thorax and high incidence of severe morbidity of Clavien-Dindo classification ≥IIIb, pneumonia, and any pulmonary morbidity. The deep-seated esophagus was also an independent risk factor for severe morbidity (hazard ratio [HR] = 5.37, 95% CI: 1.307-22.03; P = 0.020), pneumonia (HR = 9.23, 95% CI: 2.150-39.60; P = 0.003), and any pulmonary morbidity (HR = 10.3, 95% CI: 2.714-38.78; P < 0.001). In conclusion, the position of the esophagus had a strong influence on the difficulty of thoracoscopic esophagectomy and the incidence of postoperative morbidities. Surgeons would be well advised to keep a careful watch perioperatively for patients with a deep-seated esophagus.
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Naoya
authors: N
authors: Yoshida
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Yoshifumi
authors: Y
authors: Baba
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Hironobu
authors: H
authors: Shigaki
authors: Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Shinya
authors: S
authors: Shiraishi
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Kazuto
authors: K
authors: Harada
authors: Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Watanabe
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Masaaki
authors: M
authors: Iwatsuki
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Junji
authors: J
authors: Kurashige
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Yasuo
authors: Y
authors: Sakamoto
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Yuji
authors: Y
authors: Miyamoto
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Takatsugu
authors: T
authors: Ishimoto
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Keisuke
authors: K
authors: Kosumi
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.
authors: Ryuma
authors: R
authors: Tokunaga
authors: Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors: Yasuyuki
authors: Y
authors: Yamashita
authors: Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan. Electronic address: hdobaba@kumamoto-u.ac.jp.
authors: Hideo
authors: H
authors: Baba
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004947:Esophagus / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013906:Thoracoscopy
keywords: Esophageal cancer; Esophageal position; Postoperative morbidity; Thoracoscopic esophagectomy