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Updated: May 19, 2026
An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Technical and perioperative outcomes of minimally invasive esophagectomy in the prone position
Ross F Goldberg1, Steven P Bowers, Michael Parker
1Department of Surgery, Mayo Clinic-Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA. rossfgoldberg@gmail.com
Background:
Minimally invasive esophagectomy (MIE) is performed through various approaches, including using video-assisted thoracoscopic surgery for mediastinal esophageal dissection. The prone technique allows for gravity-aided retraction of the lung. The aim of this study was to examine perioperative outcomes after prone MIE in relation to patient preoperative comorbidities.
Methods:
A retrospective cohort study from our single tertiary-care center is presented. Between January 2007 and August 2010, a total of 42 patients underwent three-field prone MIE. The majority of patients were male (37 vs. 5 female), with an average age of 68 years (range = 37-87). The diagnoses for patients who underwent MIE were 35 adenocarcinoma, four Barrett's esophagus with high-grade dysplasia, two achalasia, and one squamous cell carcinoma. Neoadjuvant chemotherapy with or without radiotherapy was administered to 16 (38 %) patients. Preoperative comorbidities were quantified using the Modified Charlson Comorbidity Index; low risk was defined as a score of 0-2 (23 patients), moderate risk 3-4 (14 patients), and high risk 5 or higher (five patients). Postoperative complications were stratified using the Clavien Classification Scale; minor complications were grades 1 and 2 and major complications were grades 3-5.
Results:
Median length of hospital stay was 8 days (range = 6-51) and median ICU stay was 2 days (range = 1-26). Average prone surgical time was 108 min (range = 67-198). Thirty-seven of 42 patients (88 %) were extubated on the day of operation. Postoperatively, all five high-risk patients had a complication, three of which were major. Eight of the 14 moderate-risk patients had a complication and three were major, and 17 of the 23 low-risk group had a complication with nine being major. There was a total of 15 major complications. Predominant complications were arrhythmias (15) and pneumonia (five), with four anastomotic leaks and two postoperative 30-day mortalities.
Conclusions:
This series supports using prone MIE. Despite a clinical pathway, including immediate extubation postoperatively, there is still a risk of pulmonary complications that appears to correlate with higher preoperative comorbidity scores.
Insights
Prone minimally invasive esophagectomy (MIE) is a viable approach for esophageal cancer. Higher preoperative comorbidity scores in patients undergoing prone MIE correlate with increased risk of pulmonary complications.
Area of Science:
- Thoracic Surgery
- Surgical Oncology
- Gastroenterology
Background:
- Minimally invasive esophagectomy (MIE) utilizes video-assisted thoracoscopic surgery for esophageal dissection.
- The prone position in MIE offers advantages like gravity-aided lung retraction.
- Assessing perioperative outcomes of prone MIE concerning patient comorbidities is crucial.
Purpose of the Study:
- To evaluate perioperative outcomes following prone minimally invasive esophagectomy (MIE).
- To analyze the relationship between preoperative patient comorbidities and outcomes after prone MIE.
Main Methods:
- Retrospective cohort study of 42 patients undergoing three-field prone MIE.
- Preoperative comorbidities quantified using the Modified Charlson Comorbidity Index (low, moderate, high risk).
- Postoperative complications stratified using the Clavien Classification Scale (minor, major).
Main Results:
- Median hospital stay was 8 days; median ICU stay was 2 days.
- 88% of patients were extubated on the day of surgery.
- Higher comorbidity scores correlated with increased rates of major postoperative complications (e.g., arrhythmias, pneumonia).
Conclusions:
- Prone MIE is a supported surgical approach for esophageal cancer treatment.
- Pulmonary complications remain a risk despite clinical pathways like immediate extubation.
- Preoperative comorbidity assessment is vital for managing risks in prone MIE.
