Comparison of CO2 artificial pneumothoraces and bronchial blockers in lymphadenectomy along the left recurrent laryngeal nerve during robot-assisted esophagectomy.

Abstract

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 CO₂ 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 CO₂ 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 CO₂ 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 CO₂ 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 CO₂ artificial pneumothorax, two-lung ventilation mode, given the reduced occurrence of related complications and length of hospitalization.