Comparison of double lung versus single lung ventilation in prone thoracoscopic esophagectomy for esophageal cancer: A multicenter cohort study.

355

Background: Single lung ventilation (SLV) is conventionally used during thoracoscopic esophagectomy for esophageal cancer; however, double lung ventilation (DLV) in the prone position may provide physiological stability and reduce pulmonary complications. Comparative clinical data in oncologic minimally invasive esophagectomy remain limited. We evaluated the impact of ventilation strategy on postoperative outcomes in patients undergoing prone thoracoscopic esophagectomy for esophageal cancer. Methods: This retrospective multicenter cohort study included 100 consecutive patients who underwent prone thoracoscopic esophagectomy for esophageal cancer over a two-year period. Patients were stratified into DLV (n=51) and SLV (n=49) groups. The primary endpoint was major pulmonary complications (PPC), defined as Grade ≥ IIIA (requiring intervention or organ support). Secondary endpoints included ICU stay, total hospital stay, 30-day mortality, and readmission. Multivariate logistic regression analysis adjusted for age and cardiopulmonary comorbidities. Results: Major PPC occurred in 35.3% of patients in the DLV group compared with 57.1% in the SLV group (p=0.044). On adjusted analysis, DLV was independently associated with significantly reduced odds of major PPC (OR 0.33, p=0.015). Median ICU stay was shorter in the DLV group (4 vs 5 days, p<0.001). No significant differences were observed in total hospital stay, 30-day mortality, or readmission. Conclusions: In patients undergoing prone thoracoscopic esophagectomy for esophageal cancer, double lung ventilation significantly reduces major pulmonary morbidity and ICU utilization compared with single lung ventilation. DLV may represent a safe and potentially superior ventilation strategy in minimally invasive esophageal cancer surgery.