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. 2022 Dec;36(12):8834-8842.
doi: 10.1007/s00464-022-09309-4. Epub 2022 May 11.

Short- and long-term outcomes of thoracoscopic esophagectomy in the prone position for esophageal squamous cell carcinoma in patients with obstructive ventilatory disorder: a propensity score-matched study

Hironobu Goto  1 , Taro Oshikiri  2 , Takashi Kato  1 , Ryuichiro Sawada  1 , Hitoshi Harada  1 , Naoki Urakawa  1 , Hiroshi Hasegawa  1 , Shingo Kanaji  1 , Kimihiro Yamashita  1 , Takeru Matsuda  1 , Yoshihiro Kakeji  1
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Short- and long-term outcomes of thoracoscopic esophagectomy in the prone position for esophageal squamous cell carcinoma in patients with obstructive ventilatory disorder: a propensity score-matched study

Hironobu Goto et al. Surg Endosc. 2022 Dec.

Abstract

Background: Many patients with esophageal squamous cell carcinoma (ESCC) have obstructive ventilatory disorder (OVD), which is considered a risk factor for postoperative pneumonia. It has been reported that thoracoscopic esophagectomy in the prone position (TEP) is less invasive and is associated with fewer postoperative respiratory complications compared with open esophagectomy. This matched-cohort study aimed to elucidate the safety and oncologic outcomes of ESCC patients with OVD who undergo TEP.

Methods: In this matched-cohort study, 237 patients with ESCC who underwent TEP between 2010 and 2018 were divided into two groups based on forced expiratory volume in 1 s/forced vital capacity. Postoperative complications (Clavien-Dindo classification grade II or higher), overall survival (OS), and disease-free survival (DFS) were compared between the two groups.

Results: Based on their propensity scores, 75 patients with normal respiratory function (NRF) and 75 with OVD were selected. The rates of postoperative pneumonia were not significantly different between the two groups (NRF group vs OVD group: 18.7% vs 18.7%; P = 1.000). The rates of recurrent laryngeal nerve palsy and anastomotic leakage were also not significantly different (NRF group vs OVD group: 12.0% vs 18.7%, P = 0.365; 18.7% vs 18.7%, P = 1.000). The 5-year OS and DFS rates in the NRF vs OVD groups were 66.2% vs 54.9% and 63.5% vs 52.9%, respectively, with no significant differences (P = 0.421, 0.197).

Conclusions: TEP can be safely performed on ESCC patients with OVD and can result in an oncological efficiency equal to that of the NRF group.

Keywords: Esophageal squamous cell carcinoma (ESCC); Obstructive ventilatory disorder (OVD); Postoperative respiratory complications; Propensity score-matched study; Short- and long-term outcomes; Thoracoscopic esophagectomy in the prone position (TEP).

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