Minimally Invasive Esophagectomy Using Alternating Left and Right Thoracic Approaches (Mie-Alrta) in the Prone Position for Advanced Esophageal Cancer

Background The minimally invasive esophagectomy (MIE) is now the standard procedure. The MIE in the prone position allows for using alternating left and right thoracic approach (ALRTA), as the absence of lung compression during MIE prevents lung damage. The esophagus is located on the left side of the trunk, therefore, closer to the left thoracic cavity. The ALRTA is appropriate for resecting advanced esophageal cancer with adherence to the descending aorta. Additionally, the #112aoP and #106tbL lymph nodes can be easily removed, as they are in the left thoracic cavity. We aim to assess the MIE-ALRTA performed at our institution. Methods Eleven patients underwent the MIE-ALRTA for advanced esophageal cancer. The left-sided procedure was performed using four ports and a pneumothorax technique, while the right-sided procedure was completed using six ports. After completing the procedure on the left side, the surgeon seamlessly transitioned to the right side to continue the operation. The short-term results and recurrences were evaluated to assess the acceptability of this technique. Results The indications included six cases of suspected T4 cancer, five cases with #112aoP LN metastasis. Patient characteristics were as follows: mean age 71 years (63–83), 11 males, location: middle/lower = 4/7, Stage II/III/IV = 1/4/6, neoadjuvant chemotherapy/neoadjuvant chemoradiotherapy = 10/1. one patient resulted in R2. All patients stayed in ICU for 2 days routinely. There were no cases of pneumonia, lymphatic leakage and severe complications. Mean hospital stay was 30 days (14–73). Three patients experienced liver metastatic recurrence, and one patient had metastasis in the #16 and #104 lymph nodes; however, no recurrences were observed in the surgical field. Conclusion The MIE-ALRTA procedure was safe, as it did not increase the risk of respiratory complications. This technique was a useful option for more advanced esophageal cases like invasive to aorta.