Efficacy of artificial pneumothorax under two-lung ventilation in video-assisted thoracoscopic surgery for esophageal ca
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and Other Interventional Techniques
Efficacy of artificial pneumothorax under two‑lung ventilation in video‑assisted thoracoscopic surgery for esophageal cancer Shinsuke Nomura1 · Hironori Tsujimoto1 · Yusuke Ishibashi1 · Seiichiro Fujishima1 · Keita Kouzu1 · Manabu Harada1 · Nozomi Ito1 · Yoshihisa Yaguchi1 · Daizoh Saitoh2 · Takehiko Ikeda3 · Kazuo Hase1 · Yoji Kishi1 · Hideki Ueno1 Received: 9 June 2019 / Accepted: 24 December 2019 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background One-lung ventilation (OLV) is the standard and widely applied ventilation approach used in video-assisted thoracoscopic surgery for esophageal cancer (VATS-e). To address the disadvantages of OLV with respect to difficulties in intubation and induction, as well as the risk of respiratory complications, two-lung ventilation (TLV) with artificial pneumothorax has been introduced for use in VATS-e. However, no studies have yet compared TLV and OLV with postoperative infection and inflammation in the prone position over time postoperatively. Here, we investigated the efficacy of TLV in patients undergoing VATS-e in the prone position. Methods Between April 2010 and December 2016, 119 patients underwent VATS-e under OLV or TLV with carbon dioxide insufflation. Clinical characteristics, surgical outcomes, and postoperative outcomes, including oxygenation and systemic inflammatory responses, were compared between patients who underwent OLV and those who underwent TLV. Results Clinical characteristics other than pT stage were comparable between groups. The TLV group had shorter thoracic operation time than the OLV group. No patients underwent conversion to open thoracotomy. The P aO2/FiO2 ratios of the TLV group on postoperative day (POD) 5 and on POD7 were significantly higher than those of the OLV group. C-reactive protein levels on POD7 were lower in the TLV group than in the OLV group. There were no significant differences with respect to postoperative complications between the OLV and TLV groups. In the TLV group, the white blood cell count on POD7 was significantly lower than that in the OLV group; body temperature showed a similar trend immediately after surgery and on POD1. Conclusions In this study, we demonstrated that, compared with OLV, TLV in the prone position provides better oxygenation and reduced inflammation in the postoperative course. Accordingly, TLV might be more useful than OLV for ventilation during esophageal cancer surgery. Keywords Esophageal carcinoma · Two-lung ventilation (TLV) · One-lung ventilation (OLV) · Thoracoscopic esophagectomy · Prone position
Electronic supplementary material The online version of this article (doi:https://doi.org/10.1007/s00464-019-07347-z) contains supplementary material, which is available to authorized users. * Hironori Tsujimoto [email protected] 1
Department of Surgery, National Defense Medical College, 3‑2 Namiki, Tokorozawa, Saitama 359‑8513, Japan
2
Division of Traumatology, National Defense Medical College Researc
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