Comparison of early postoperative pulmonary complications between two-lung ventilation with artificial pneumothorax and one-lung ventilation with bronchial blockade in patients undergoing minimally invasive esophagectomy: a retrospective propensity score-matched cohort study

Xiaoxi Li; Ling Yu; Jiaonan Yang; Miao Fu; Hongyu Tan

doi:10.21037/jtd-23-1667

Comparison of early postoperative pulmonary complications between two-lung ventilation with artificial pneumothorax and one-lung ventilation with bronchial blockade in patients undergoing minimally invasive esophagectomy: a retrospective propensity score-matched cohort study

J Thorac Dis. 2024 Mar 29;16(3):1777-1786. doi: 10.21037/jtd-23-1667. Epub 2024 Mar 6.

Authors

Xiaoxi Li¹, Ling Yu¹, Jiaonan Yang¹, Miao Fu¹, Hongyu Tan¹

Affiliation

¹ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, China.

Abstract

Background: Two-lung ventilation (TLV) with artificial carbon dioxide (CO₂) pneumothorax is used during the thoracoscopic phase of minimally invasive esophagectomy (MIE). However, the impact of TLV with artificial pneumothorax on postoperative pulmonary complications (PPCs) after MIE is unclear. This study aimed to compare the incidence of early PPCs between TLV with CO₂ pneumothorax and one-lung ventilation (OLV) with bronchial blockade in patients undergoing MIE.

Methods: Five hundred ninety-three patients with esophageal cancer who underwent elective MIE with two-field lymph node dissection were analyzed. Patients in the TLV group were intubated using a single-lumen endotracheal tube and underwent surgery using TLV with artificial CO₂ pneumothorax. Patients in the OLV group underwent surgery using OLV with a bronchial blocker. Patient characteristics and intraoperative and PPC data were collected and analyzed. Propensity score matching (PSM) was performed to reduce confounding bias.

Results: The TLV and OLV group comprised 513 and 80 patients, respectively. PSM matched 197 TLV group and 73 OLV group patients. Incidence of pneumonia within the first 3 days of surgery was higher in the TLV group (11.7% vs. 4.1%) but the difference was not significant (P=0.06). The incidence of infiltrates on chest radiography was 36.0% in the TLV group and 28.8% in the OLV group (P=0.26). Incidence of other major PPCs requiring treatment and major non-pulmonary postoperative complications did not significantly differ between the groups. Length of hospital stay was significantly longer in the TLV group (13.0 vs. 11.0 days; P=0.03).

Conclusions: Compared with OLV with bronchial blockade, TLV with CO₂ pneumothorax did not reduce the incidence of early PPCs after MIE.

Keywords: Esophageal cancer; minimally invasive esophagectomy (MIE); one-lung ventilation (OLV); postoperative pulmonary complications (PPCs); two-lung ventilation (TLV).