Comparison of CO artificial pneumothoraces and bronchial blockers in lymphadenectomy along the left recurrent laryngeal nerve during robot-assisted esophagectomy.

BACKGROUND

To analyze the effects of different intubation and ventilation modes on left recurrent laryngeal nerve lymph node dissection and postoperative complications in patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE).

METHODS

Overall, 339 patients with esophageal cancer who underwent RAMIE at Tianjin Medical University Cancer Hospital between June 2017 and December 2021 were selected for this retrospective study. The effects of CO artificial pneumothorax and bronchial blockers on the number of lymph nodes dissected and the incidence of postoperative complications were compared.

RESULTS

Among 339 patients, 111 underwent surgery using CO artificial pneumothorax, while 228 used bronchial occlusion devices. There were no significant differences in baseline characteristics between the two groups (p > 0.05). The total number of lymph nodes dissected (31.11 ± 13.00 vs. 24.42 ± 11.10, p < 0.001), the number of thoracic lymph nodes dissected (19.53 ± 9.80 vs. 15.00 ± 7.85, p < 0.001), and the number of lymph nodes dissected around the left recurrent laryngeal nerve (3.62 ± 3.19 vs. 2.72 ± 3.18, p = 0.015) were significantly higher in the bronchial occlusion group than in compared to the CO pneumothorax ventilation group. There were no significant differences in the number of right recurrent laryngeal lymph node dissection between the two groups (3.15 ± 2.89 vs. 2.68 ± 2.25, p = 0.132). The incidence of recurrent laryngeal nerve injury was significantly lower in the bronchoclusive single-lung ventilation group than in the CO artificial pneumothorax group (15 [6.57%] vs. 17 [15.31%], p = 0.010). There were no significant differences in the incidence of overall postoperative complications, including pulmonary complications, anastomotic fistula, chylothorax, incision infection, or cardiovascular complications (all p > 0.05). However, a significant difference was noted in the Clavien-Dindo grading of postoperative complications (p = 0.016) and the number of days of hospitalization between the two groups (17.93 ± 9.98 vs. 14.48 ± 10.45, p = 0.004).

CONCLUSIONS

The bronchial blocker, one-lung ventilation mode was found to be more advantageous in lymphadenectomies than the CO artificial pneumothorax, two-lung ventilation mode, given the reduced occurrence of related complications and length of hospitalization.