Effect of Esophagus Position on Surgical Difficulty and Postoperative Morbidities After Thoracoscopic Esophagectomy

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• 作者：Naoya Yoshida ; MD ; PhD^⁎ ; Yoshifumi Baba ; MD ; PhD^⁎ ; Hironobu Shigaki ; MD ; PhD^⁎ ; Shinya Shiraishi ; MD ; PhD^&dagger ; ; Kazuto Harada ; MD ; PhD^⁎ ; Masayuki Watanabe ; MD ; PhD^&Dagger ; ; Masaaki Iwatsuki ; MD ; PhD^⁎ ; Junji Kurashige ; MD ; PhD^⁎ ; Yasuo Sakamoto ; MD ; PhD^⁎ ; Yuji Miyamoto ; MD ; PhD^⁎ ; Takatsugu Ishimoto ; MD ; PhD^⁎ ; Keisuke Kosumi ; MD^⁎ ; Ryuma Tokunaga ; MD^⁎ ; Yasuyuki Yamashita ; MD ; PhD^&dagger ; ; Hideo Baba ; MD ; PhD^⁎ ; ^{hdobaba@kumamoto-u.ac.jp" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Esophageal cancer ; Esophageal position ; Postoperative morbidity ; Thoracoscopic esophagectomy
• 刊名：Seminars in Thoracic and Cardiovascular Surgery
• 出版年：2016
• 出版时间：Spring 2016
• 年：2016
• 卷：28
• 期：1
• 页码：172-179
• 全文大小：652 K

文摘

The objective include thoracoscopic esophagectomy for the deep-seated (left-sided) esophagus has several technical difficulties, which may affects the intraoperative or postoperative outcomes. However, no previous studies have focused on the correlation between the position of the esophagus and short-term outcome after thoracoscopic esophagectomy. Of 470 esophagectomies between April 2005 and April 2015 in Kumamoto University Hospital, 112 patients who underwent thoracoscopic esophagectomy for esophageal cancer were examined. The position of the esophagus was divided into 2 types: deep-seated esophagus or another type based on computed tomographic images in the supine position. In results, the deep-seated esophagus was associated with a longer operation time in the thorax and high incidence of severe morbidity of Clavien-Dindo classification ≥IIIb, pneumonia, and any pulmonary morbidity. The deep-seated esophagus was also an independent risk factor for severe morbidity (hazard ratio [HR] = 5.37, 95% CI: 1.307-22.03; P = 0.020), pneumonia (HR = 9.23, 95% CI: 2.150-39.60; P = 0.003), and any pulmonary morbidity (HR = 10.3, 95% CI: 2.714-38.78; P < 0.001). In conclusion, the position of the esophagus had a strong influence on the difficulty of thoracoscopic esophagectomy and the incidence of postoperative morbidities. Surgeons would be well advised to keep a careful watch perioperatively for patients with a deep-seated esophagus.