Carbon dioxide gas-induced pneumothorax versus one-lung ventilation in minimally invasive esophagectomy: A multicenter propensity score matching cohort study
Junying Chen, Jiao Heng, Bin Zheng, Taidui Zeng, Hao Wang, Peizong Wang, Yaobin Lin, Wuyou Gao, Chun Chen, Lijie Tan, Jianhua Fu- General Medicine
- Surgery
Background:
Carbon dioxide gas-induced pneumoperitoneum might be the reason for the shorter postoperative survival of patients with malignant tumors. Whether CO2 gas-induced pneumothorax has unfavorable impacts on the surgical and oncological outcomes of minimally invasive esophagectomy remains unclear.
Methods:
Between 2010 and 2016, a total of 998 patients with squamous cell carcinoma of the esophagus who received video-assisted surgery were registered from three large-volume medical centers. The overall survival and disease-free survival were compared after using propensity score-matched and inverse probability-weighted methods. In addition, the tumor-relapse state was evaluated, and the relapse pattern was compared.
Results:
A total of 422 and 576 minimally invasive esophagectomies with intraoperative one-lung ventilation and CO2-induced pneumothorax were enrolled, respectively. The 5-year overall survival and disease-free survival were similar between the CO2-induced pneumothorax (64.2% and 64.7%) and one-lung ventilation (65.3% and 62.4%) groups following propensity matching. The inverse probability weighting revealed similarly equal survival results in the two groups. The 5-year relapse rates were 35.1% and 30.6% in the one-lung ventilation and CO2-induced pneumothorax groups, respectively. Moreover, the relapse patterns were not significantly different between the two groups.
Conclusion:
The results of this study suggested that the use of intraoperative one-lung ventilation and CO2-induced pneumothorax have similar oncological outcomes; therefore, the two methods are both viable options in esophagectomy.