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Factors influencing difficulty of the thoracic procedure in minimally invasive esophagectomy

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Abstract

Background

Minimally invasive esophagectomy (MIE) is being increasingly performed worldwide. When performing MIE, we sometimes experienced difficulties due to a narrow upper mediastinum or a middle to lower thoracic esophagus hidden by the projection of the vertebral body. However, there were no reports regarding the influence of anatomical factors on the difficulty of performing MIE. The aim of this study was to evaluate whether anatomical factors could be related to the difficulty of the thoracic procedure in MIE.

Methods

We investigated 87 consecutive patients undergoing MIE for primary esophageal cancer between 2013 and 2015 and created novel indices to assess the upper mediastinal narrowness and vertebral body projection at middle thoracic part on preoperative computed tomography images. We assessed clinicopathological and anatomical factors and determined the factors influencing the thoracic procedural difficulty in MIE. The thoracic procedure duration was selected as the variable representing technical difficulty.

Results

The mean thoracic procedure duration was 280.2 ± 52.5 min. There were no significant correlations between the indices and patient factors such as age, sex, and body mass index. Meanwhile, there was a significant correlation between the upper mediastinal narrowness and the vertebral body projection (p < 0.01). Of the clinicopathological and anatomical factors, blood loss during the thoracic procedure, thoracic duct resection, and vertebral body projection independently were related to the prolonged thoracic procedure duration in multiple linear regression analysis (p = 0.01, 0.03, and <0.01, respectively). The other factors including upper mediastinal narrowness were not statistically significant.

Conclusions

This is the first study to reveal the influence of anatomical factors on the difficulty of the thoracic procedure in MIE. The vertebral body projection at middle thoracic part appears to be a useful tool for predicting the thoracic procedural difficulty in MIE preoperatively.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Akihiko Okamura, Masayuki Watanabe, Shinji Mine, Koujiro Nishida, Yu Imamura, Takanori Kurogochi & Takeshi Sano

  2. Department of Surgery, School of Medicine, Keio University, Tokyo, Japan

    Yuko Kitagawa

Authors
  1. Akihiko Okamura
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  2. Masayuki Watanabe
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  3. Shinji Mine
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  4. Koujiro Nishida
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  5. Yu Imamura
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  6. Takanori Kurogochi
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  7. Yuko Kitagawa
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  8. Takeshi Sano
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Corresponding author

Correspondence to Masayuki Watanabe.

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Disclosures

Drs. Akihiko Okamura, Masayuki Watanabe, Shinji Mine, Koujiro Nishida, Yu Imamura, Takanori Kurogochi, Yuko Kitagawa, and Takeshi Sano have no conflicts of interest or financial ties to disclose.

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Okamura, A., Watanabe, M., Mine, S. et al. Factors influencing difficulty of the thoracic procedure in minimally invasive esophagectomy. Surg Endosc 30, 4279–4285 (2016). https://doi.org/10.1007/s00464-015-4743-3

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  • DOI: https://doi.org/10.1007/s00464-015-4743-3

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