Kuwabara Shirou, Kobayashi Kazuaki, Kubota Akira, Shioi Ikuma, Yamaguchi Kenji, Katayanagi Norio
Department of Digestive Surgery, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata City, Niigata Prefecture, 950-1197, Japan.
Langenbecks Arch Surg. 2018 Aug;403(5):607-614. doi: 10.1007/s00423-018-1674-1. Epub 2018 Apr 15.
The aim of this study was to clarify the differences between thoracoscopic esophagectomy in the left decubitus position (LP) and in the prone position (PP) in terms of short-term perioperative outcomes and long-term oncological outcomes after more than 5 years of follow-up.
Patients with esophageal cancer who underwent thoracoscopic esophagectomy and were followed up for more than 5 years were analyzed retrospectively. Of 142 patients, 72 underwent LP esophagectomy and 70 underwent PP esophagectomy. Operation time, blood loss, operative morbidity, mortality, length of hospital stay, and the number of dissected lymph nodes were compared to evaluate short-term outcomes. Cancer recurrence and overall survival were compared to examine long-term outcomes.
Patient and tumor characteristics were not different between the LP and PP groups except for the rate of neoadjuvant chemotherapy. Blood loss was significantly lower in the PP group than in the LP group. Incidence of Clavien-Dindo (C.D.) grade ≥ III complications was significantly lower in the PP group than in the LP group. Pulmonary complications were also significantly lower in the PP group than in the LP group. Operation type (LP versus PP) was identified as an independent risk factor for pulmonary complications (odds ratio 0.27, p = 0.03) by multivariate analysis. Cancer recurrence rate, initial recurrence site, and overall survival rate were not different between the two groups.
PP is regarded as a less invasive procedure than LP with the same oncological effect.
本研究旨在阐明左侧卧位（LP）和俯卧位（PP）胸腔镜食管切除术在短期围手术期结局以及5年以上随访后的长期肿瘤学结局方面的差异。
对接受胸腔镜食管切除术并随访超过5年的食管癌患者进行回顾性分析。142例患者中，72例行LP食管切除术，70例行PP食管切除术。比较手术时间、失血量、手术并发症、死亡率、住院时间和清扫淋巴结数量以评估短期结局。比较癌症复发和总生存率以检查长期结局。
除新辅助化疗率外，LP组和PP组患者及肿瘤特征无差异。PP组失血量显著低于LP组。PP组Clavien-Dindo（C.D.）≥III级并发症发生率显著低于LP组。PP组肺部并发症也显著低于LP组。多因素分析确定手术方式（LP与PP）是肺部并发症的独立危险因素（比值比0.27，p = 0.03）。两组癌症复发率、初始复发部位和总生存率无差异。
PP被认为是一种比LP侵入性更小的手术方式，且具有相同的肿瘤学效果。
