Outcomes of Three-Port Minimally Invasive Transthoracic Esophagectomy in Prone Position for Resectable Esophageal...

Esophageal cancer surgery is a complex procedure with significant challenges and high morbidity. This study offers a comprehensive analysis of patients undergoing three-port minimally invasive transthoracic esophagectomy with comprehensive mediastinal lymphadenectomy (3P-MIE) in the prone position, focusing on surgical technique, morbidity, mortality, histological findings, and survival outcomes. Data from 176 patients who underwent 3P-MIE for resectable esophageal cancer in the prone position from January 2010 to March 2023 were analyzed. Most patients underwent a two-field lymphadenectomy (n = 173), while three patients had three-field nodal dissection. Thoracic component was performed thoracoscopically, while abdominal component through laparoscopy or mini laparotomy. Cervical esophagogastric anastomosis was performed in all patients using a semi-mechanical technique. The demographic data showed a median age of 52 years (range 21-73), with 99 females and 77 males. The predominant histology was squamous cell carcinoma (SCC) (86%). Twenty-seven patients underwent upfront surgery (15%), neoadjuvant chemoradiation (NACRT) was delivered to 135 cases (77%), neoadjuvant chemotherapy (NACT) in 11 (7%), and salvage surgery in 3 (2%). Surgical details revealed a median operative time of 370 min (range 90-580) and a median blood loss of 175 mL (range 50-2000 mL). Forty-nine percent (n = 87) of the patients experienced complications of grade 2 or greater according to the Clavien-Dindo classification. Anastomotic leaks occurred in 14.7% of cases, and pneumonia in 17.6%. The median ICU stay was 4 days (range 2-22), and median hospital stay of 9 days (range 5-38). Thirty-day mortality was observed in 5% (n = 9), and 90-day mortality in 6.25% (n = 11). A median of 20 nodes were retrieved, with R0 resection achieved in 96.6% of cases. With a median follow-up of 60 months, the median overall survival (OS) was 62.5%, and the median disease-free survival (DFS) was not reached. Three-port minimally invasive transthoracic esophagectomy in the prone position is a feasible and safe approach, achieving good mediastinal clearance and high R0 resection rates.