Thoraco-laparoscopic esophagectomy: thoracic stage in prone position

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Gastrointestinal Surgery

Background:

• Esophageal cancer treatment often requires complex surgical interventions.
• Thoraco-laparoscopic esophagectomy offers a minimally invasive alternative to open procedures.
• The prone position during the thoracic stage may enhance surgical visualization and access.

Purpose of the Study:

• To evaluate the initial experience and outcomes of thoraco-laparoscopic esophagectomy with a prone thoracic stage.
• To assess the safety, efficacy, and oncological results of this approach at the National Cancer Institute Abdominopelvic Division (INCA / MS/HC I).

Main Methods:

• A retrospective study of 19 consecutive thoraco-laparoscopic esophagectomies performed between May 2012 and August 2014.
• Procedures included patients with squamous cell carcinoma and gastroesophageal junction adenocarcinoma.
• All surgeries featured a prone position for the thoracic stage.

Main Results:

• The procedure demonstrated minimal blood loss, optimal mediastinal visualization, and oncological radicality with no conversions.
• Surgical morbidity was 42%, with most complications being minor (Clavien I or II).
• The most frequent complication was cervical anastomotic leak (37%), with a low stricture rate (10.53%).

Conclusions:

• Thoraco-laparoscopic esophagectomy in the prone position is a safe and effective technique for esophageal cancer.
• The approach facilitates good lymph node sampling, crucial for accurate cancer staging.
• This minimally invasive method provides favorable oncological and short-term outcomes.