Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier St Louis-Lariboisière, Department of Anaesthesiology and Critical Care and Burn Unit, Paris, France.
Fattouma Bourguiba Hospital, Department of Visceral Surgery, Monastir, Tunis.
Anaesth Crit Care Pain Med. 2022 Oct;41(5):101134. doi: 10.1016/j.accpm.2022.101134. Epub 2022 Jul 27.
Esophageal cancer surgery is still carrying a high risk of morbidity and mortality. That is why some anesthesia strategies have tried to reduce those postoperative complications. In this systematic review performed in accordance with the PRISMA-S guidelines (PROSPERO (ID: CRD42022310385)), we aimed to investigate the safety and advantages of two-lung ventilation (TLV) over one-lung ventilation (OLV) in minimally invasive esophagectomy (MIE) in the prone position. Seven trials, with a total number of 1710 patients (765 patients with TLV versus 945 patients with OLV) were included. Postoperative mortality and morbidity rates were similar between TLV and OLV when realised for esophagectomy. Interestingly, we observed no difference in changes in intraoperative respiratory parameters, operative duration, thoraco-conversion rate, number of harvested lymph nodes, postoperative heart rate and respiratory rate between TLV and OLV. TLV brings better results in terms of intraoperative oxygen arterial pressure (PaO) during the thoracic time, postoperative oxygenation, PaO on inspired fraction of oxygen (FiO) ratio, duration of thoracic surgery, preoperative time, blood loss, temperature on postoperative day-1, and C-reactive protein dosage. Our study highlighted the safety of TLV for MIE in prone position when compared to OLV. Interestingly, we found better intra and postoperative ventilation parameters. The choice of ventilation modality did not influence clinical outcome after surgery and the quality of oncological resection. Large randomised controlled trials are needed to confirm these results.
食管癌手术仍然存在较高的发病率和死亡率。这就是为什么一些麻醉策略试图减少这些术后并发症。在这项按照 PRISMA-S 指南（PROSPERO（ID：CRD42022310385））进行的系统评价中，我们旨在研究双肺通气（TLV）与单肺通气（OLV）在俯卧位微创食管切除术（MIE）中的安全性和优势。共有 7 项试验，共纳入 1710 例患者（TLV 组 765 例，OLV 组 945 例）。在进行食管切除术时，TLV 和 OLV 的术后死亡率和发病率相似。有趣的是，我们观察到术中呼吸参数、手术时间、转换率、淋巴结采集数量、术后心率和呼吸率在 TLV 和 OLV 之间没有差异。在胸段期间，TLV 在术中氧动脉压（PaO）、术后氧合、吸入氧分数（FiO）比值的 PaO、胸科手术持续时间、术前时间、出血量、术后第 1 天的体温和 C 反应蛋白剂量方面有更好的结果。与 OLV 相比，我们的研究强调了 TLV 在俯卧位 MIE 中的安全性。有趣的是，我们发现更好的术中及术后通气参数。通气方式的选择并不影响术后临床结果和肿瘤切除质量。需要进行大规模的随机对照试验来证实这些结果。
