The surgical outcome of minimally invasive pharyngo-laryngo-oesophagectomy in prone position
Mariko Ogino1, Yuma Ebihara1, Akihiro Homma2, Kimitaka Tanaka1, Yoshitsugu Nakanishi1, Toshimichi Asano1, Takehiro Noji1, Yo Kurashima1, Soichi Murakami1, Toru Nakamura1, Takahiro Tsuchikawa1, Keisuke Okamura1, Toshiaki Shichinohe1, Satoshi Hirano1
1 Department of Gastroenterological Surgery, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
2 Department of Otolaryngology, Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, N15W7,Kita-ku, Sapporo, Hokkaido 060-8638
Source of Support: None, Conflict of Interest: None
Purpose: Pharyngo-laryngo-oesophagectomy (PLE) which is mainly indicated for cervical oesophageal cancer or synchronous double cancer of the thoracic oesophagus and the pharynx or larynx, is extremely invasive. Since minimally invasive oesophagectomy (MIE) using video-assisted thoracic surgery has become popular recently, the procedure can be adopted to PLE. Moreover, the use of the prone position (PP) in MIEs has been increasing recently because technical advantages and fewer post-operative complications were reported. To assess the validity of PP, this study compared surgical outcomes of minimally invasive PLE (MIPLE) in PP with that in the left lateral decubitus position (LLDP).
Patients and Methods: This study enrolled consecutive 15 patients that underwent MIPLE with LLDP (n = 7) or PP (n = 8) between January 1996 and October 2016. The patients' background characteristics, operative findings and post-operative complications were examined.
Results: Eligible diseases are 5 cases of cervical oesophageal cancer, 9 cases of synchronous double cancer of the thoracic oesophagus and head and neck and 1 case of cervical oesophageal recurrence of the head-and-neck cancer. The patients' background characteristics were not significantly different. During surgery, thoracic blood loss was significantly lower in PP than in LLDP (P = 0.0487). Other operative findings and post-operative complications were not significantly different between the two groups.
Conclusions: In MIPLE, the PP could reduce blood loss due to the two-lung ventilation under artificial pneumothorax and was associated with lower surgical stress than LLDP.