{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T01:27:00Z","timestamp":1779154020783,"version":"3.51.4"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"11","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100014584","name":"Universit\u00e4tsmedizin der Johannes Gutenberg-Universit\u00e4t Mainz","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100014584","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Introduction<\/jats:title>\n                <jats:p>Minimally invasive esophagectomy (MIE) for esophageal cancer is a complex procedure that reduces postoperative morbidity in comparison to open approach. In this study, thoracic cage width as a factor to predict surgical difficulty in MIE was evaluated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>All patients of our institution receiving either total MIE or robotic-assisted MIE (RAMIE) with intrathoracic anastomosis between February 2016 and April 2021 for esophageal cancer were included in this study. Right unilateral thoracic cage width on the level of vena azygos crossing the esophagus was measured by the horizontal distance between the esophagus and parietal pleura on preoperative computer tomography. Patients\u2019 data as well as operative and postoperative details were collected in a prospective database. Correlation between thoracic cage width with duration of the thoracic procedure and postoperative complication rates was analyzed.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Overall, 313 patients were eligible for this study. Thoracic width on vena azygos level ranged from 85 to 149 mm with a mean of 116.5 mm. In univariate analysis, a small thoracic width significantly correlated with longer duration of the thoracic procedure (<jats:italic>p<\/jats:italic>\u2009=\u20090.014). In multivariate analysis, small thoracic width and neoadjuvant therapy were identified as independent factors for long duration of the thoracic procedure (<jats:italic>p<\/jats:italic>\u2009=\u20090.006). Regarding postoperative complications, thoracic cage width was a significant risk factor for occurrence of postoperative pneumonia in the multivariate analysis (<jats:italic>p<\/jats:italic>\u2009=\u20090.045). Dividing the cohort into two groups of patients with narrow (\u2264\u2009107 mm, 19.5%) and wide thoraces (\u2265\u2009108 mm, 80.5%), the thoracic procedure was significantly prolonged by 17 min (204 min vs. 221 min, <jats:italic>p<\/jats:italic>\u2009=\u20090.014).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>A small thoracic cage width is significantly correlated with longer operation time during thoracic phase of a MIE in Europe, which suggests increased surgical difficulty. Patients with small thoracic cage width may preferably be operated by MIE-experienced surgeons.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Graphical abstract<\/jats:title>\n                \n              <\/jats:sec>","DOI":"10.1007\/s00464-023-10340-2","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T16:02:35Z","timestamp":1694102555000},"page":"8301-8308","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Effect of thoracic cage width on surgery time and postoperative outcome in minimally invasive esophagectomy"],"prefix":"10.1007","volume":"37","author":[{"given":"C.","family":"Mann","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T.","family":"Jezycki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"F.","family":"Berlth","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Hadzijusufovic","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Uzun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A.","family":"M\u00e4hringer-Kunz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H.","family":"Lang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R.","family":"Kl\u00f6ckner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1859-9213","authenticated-orcid":false,"given":"P. P.","family":"Grimminger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"issue":"6","key":"10340_CR1","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.1007\/s12328-020-01237-x","volume":"13","author":"DJ Uhlenhopp","year":"2020","unstructured":"Uhlenhopp DJ et al (2020) Epidemiology of esophageal cancer: update in global trends, etiology and risk factors. Clin J Gastroenterol 13(6):1010\u20131021","journal-title":"Clin J Gastroenterol"},{"issue":"2","key":"10340_CR2","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/SLA.0000000000002611","volume":"269","author":"DE Low","year":"2019","unstructured":"Low DE et al (2019) Benchmarking complications associated with esophagectomy. Ann Surg 269(2):291\u2013298","journal-title":"Ann Surg"},{"issue":"1","key":"10340_CR3","first-page":"7","volume":"37","author":"A Cuschieri","year":"1992","unstructured":"Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37(1):7\u201311","journal-title":"J R Coll Surg Edinb"},{"key":"10340_CR4","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1471-2482-11-2","volume":"11","author":"SS Biere","year":"2011","unstructured":"Biere SS et al (2011) Traditional invasive vs minimally invasive esophagectomy: a multi-center, randomized trial (TIME-trial). BMC Surg 11:2","journal-title":"BMC Surg"},{"issue":"3","key":"10340_CR5","doi-asserted-by":"publisher","first-page":"165","DOI":"10.1111\/ans.13334","volume":"87","author":"WL Xiong","year":"2017","unstructured":"Xiong WL et al (2017) Comparison of outcomes between minimally invasive oesophagectomy and open oesophagectomy for oesophageal cancer. ANZ J Surg 87(3):165\u2013170","journal-title":"ANZ J Surg"},{"issue":"9","key":"10340_CR6","doi-asserted-by":"publisher","first-page":"3873","DOI":"10.1007\/s00464-015-4692-x","volume":"30","author":"W Guo","year":"2016","unstructured":"Guo W et al (2016) Combined thoracoscopic\u2013laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc 30(9):3873\u20133881","journal-title":"Surg Endosc"},{"issue":"1","key":"10340_CR7","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1186\/s12957-016-1062-7","volume":"14","author":"W Yibulayin","year":"2016","unstructured":"Yibulayin W et al (2016) Minimally invasive oesophagectomy versus open esophagectomy for resectable esophageal cancer: a meta-analysis. World J Surg Oncol 14(1):304","journal-title":"World J Surg Oncol"},{"issue":"2","key":"10340_CR8","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1097\/SLA.0b013e3181b13ca2","volume":"250","author":"PA Clavien","year":"2009","unstructured":"Clavien PA et al (2009) The Clavien\u2013Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187\u2013196","journal-title":"Ann Surg"},{"issue":"2","key":"10340_CR9","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1093\/dote\/doac044","volume":"36","author":"C Froiio","year":"2023","unstructured":"Froiio C et al (2023) Semiprone thoracoscopic approach during totally minimally invasive Ivor-Lewis esophagectomy seems to be beneficial. Dis Esophagus 36(2):44","journal-title":"Dis Esophagus"},{"issue":"5","key":"10340_CR10","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1055\/s-0038-1636933","volume":"66","author":"PP Grimminger","year":"2018","unstructured":"Grimminger PP et al (2018) The da Vinci Xi robotic four-arm approach for robotic-assisted minimally invasive esophagectomy. Thorac Cardiovasc Surg 66(5):407\u2013409","journal-title":"Thorac Cardiovasc Surg"},{"issue":"1","key":"10340_CR11","doi-asserted-by":"publisher","first-page":"172","DOI":"10.1053\/j.semtcvs.2015.12.002","volume":"28","author":"N Yoshida","year":"2016","unstructured":"Yoshida N et al (2016) Effect of esophagus position on surgical difficulty and postoperative morbidities after thoracoscopic esophagectomy. 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Ann Surg Oncol 24(7):1821\u20131827","journal-title":"Ann Surg Oncol"},{"issue":"1","key":"10340_CR14","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1097\/SLA.0000000000002469","volume":"269","author":"F van Workum","year":"2019","unstructured":"van Workum F et al (2019) Learning curve and associated morbidity of minimally invasive esophagectomy: a retrospective multicenter study. Ann Surg 269(1):88\u201394","journal-title":"Ann Surg"},{"issue":"8","key":"10340_CR15","doi-asserted-by":"publisher","first-page":"3479","DOI":"10.1007\/s00464-019-07125-x","volume":"34","author":"S Takeno","year":"2020","unstructured":"Takeno S et al (2020) Utility of thoracic cage width in assessing surgical difficulty of minimally invasive esophagectomy in left lateral decubitus position. Surg Endosc 34(8):3479\u20133486","journal-title":"Surg Endosc"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-023-10340-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-023-10340-2\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-023-10340-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T16:11:46Z","timestamp":1704730306000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-023-10340-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":15,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10340"],"URL":"https:\/\/doi.org\/10.1007\/s00464-023-10340-2","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]},"assertion":[{"value":"30 January 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 July 2023","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 September 2023","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Carolina Mann, Thomas Jezycki, Felix Berlth, Edin Hadzijusufovic, Eren Uzun, Hauke Lang, Aline M\u00e4hringer-Kunz, Roman Kl\u00f6ckner, and Peter Philipp Grimminger have no conflicts of interest or financial ties to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclosures"}},{"value":"The study was conducted according to the guidelines of the Declaration of Helsinki 1975 and approved by the Ethics Committee of the state of Rhineland-Palatinate.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}