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Long-Term Outcomes of Thoracoscopic Esophagectomy in the Prone versus Lateral Position: A Propensity Score-Matched Analysis

Susumu Miura MD, Tetsu Nakamura PhD, MD, Yukiko Miura MD, Gosuke Takiguchi PhD, MD, Nobuhisa Takase PhD, MD, Hiroshi Hasegawa PhD, MD, Masashi Yamamoto PhD, MD, Shingo Kanaji PhD, MD, Yoshiko Matsuda PhD, MD, Kimihiro Yamashita PhD, MD, Takeru Matsuda PhD, MD, Taro Oshikiri PhD, MD, Satoshi Suzuki PhD, MD, Yoshihiro Kakeji PhD, MD
Thoracic Oncology
Volume 26, Issue 11 / October , 2019

Abstract

Background

Several studies have suggested that thoracoscopic esophagectomy (TE) in the prone position (TEP) may be more feasible than TE in the lateral position (TEL); however, few studies have compared long-term survival between the two procedures. We evaluated whether TEP is oncologically equivalent to TEL.

Methods

Surgical outcomes of TEs performed from January 2006 to December 2013 at our hospital were retrospectively analyzed. Propensity score matching was used to control for confounding factors.

Results

TE was performed in 200 patients diagnosed with esophageal squamous cell carcinoma; 78 patients were matched in two procedures. The mean thoracic operative time in TEL was shorter than in TEP (228.9 min vs. 299.1 min; p < 0.001); however, the mean thoracic blood loss in TEL was higher than in TEP (186.9 ml vs. 76.5 ml; p < 0.001). The mean number of thoracic lymph nodes harvested in TEL was lower than in TEP (23.5 vs. 26.9; p < 0.05), and the pulmonary complication rate in TEL was higher than in TEP (30.8% vs. 15.4%; p < 0.05). The 5-year overall survival rates in pathological stage I (81.2% vs. 81.6%; p = 0.82), stage II (65.3% vs. 80.9%; p = 0.21), stage III (26.7% vs. 24.2%; p = 0.86) and all stages (63.6% vs. 62.3%; p = 0.88), and the 5-year progression-free survival rates in pathological stage I (78.0% vs. 81.8%; p = 0.54), stage II (53.5% vs. 77.6%; p = 0.13), stage III (10.5% vs. 12.8%; p = 0.81) and all stages (53.6% vs. 57.9%; p = 0.50) were not significantly different between the two procedures.

Conclusion

TEP and TEL provide equal oncological efficiency.

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