Comparison of the perioperative outcome of esophagectomy by thoracoscopy in the prone position with that of thoracotomy in the lateral decubitus position

Purpose: Traditional esophagectomy is a highly invasive procedure. Intrathoracic procedures in esophagectomy can be performed by thoracoscopy. This study compared the influence of prone positioning with that of lateral decubitus positioning on patient outcomes following esophagectomy. Methods: This study enrolled 24 patients that underwent esophagectomy with thoracoscopy in the prone position between July 2009 and November 2010 (group P) and 24 patients that underwent thoracotomy in the lateral decubitus position between July 2007 and June 2009 (group L). The ICU and hospital stay length, pulmonary complication frequency and time until walking ability was regained were recorded. Results: The patients' background was not significantly different. Total blood loss and pulmonary complication frequency were significantly lower in group P than in group L [209 (SD; 146) vs. 474 (279) ml, P = 0.002, and 4 vs. 38 %, P = 0.003]. The duration of ICU stay, time until walking ability was regained and hospital stay were significantly shorter in group P than in group L [865 (103) vs. 1349 (702) min, P = 0.002, 1.0 (0.2) vs. 3.1 (2.5) POD, P < 0.001 and 23 (16) vs. 35 (15) POD, P = 0.009]. Conclusion: Thoracoscopic surgery in the prone position allows for earlier mobilization and also reduces respiratory complications.