Comparison between neck-first approach and thoracic approach during thoracoscopic esophagectomy

Abstract

Purpose: This study aimed to compare the outcomes of the prior cervical and thoracic approaches of thoracoscopic esophagectomy in the prone position for esophageal cancer. Methods: We reviewed the records of 103 consecutive patients who underwent thoracoscopic esophagectomy in the prone position for esophageal cancer. Seventy-four patients underwent the prior cervical approach (Cervical group); the other 29 underwent the thoracic approach (Thoracic group). The perioperative outcomes of the two groups were compared. Results: Total operative time and volume of blood loss were not different between the two groups, but the median thoracoscopic time was significantly longer in the Thoracic group than in the Cervical group (296 vs. 210 min; P < 0.001). The incidence of recurrent nerve palsy was not different; however, the incidence of the postoperative pneumonia tended to be higher in the Thoracic group than in the Cervical group (20.7 vs. 10.8%; P = 0.188), and the duration of postoperative hospital stay was significantly longer in the Thoracic group than in the Cervical group (22 vs. 17 days; P = 0.032). Conclusion: Patients who underwent thoracoscopic esophagectomy in the prone position via the prior cervical approach had better short-term outcomes than those who underwent the thoracic approach.