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Double-lumen tube versus bronchial blocker in lymphadenectomy along the left recurrent laryngeal nerve for esophageal cancer: a propensity-matched analysis

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AbstractQuery

Background

Lymph node (LN) dissection along left recurrent laryngeal nerve (RLN) is challenging in esophagectomy for esophageal cancer, and double-lumen endotracheal tube (DLT) impedes the exposure of this area. The aim of this study was to determine whether bronchial blockers (BB) could be a better choice for this procedure.

Methods

The clinical characteristics of patients who received McKeown esophagectomy with radical lymph node dissection in Wuhan Tongji Hospital between August 2017 and July 2019 were retrospectively analyzed. The 1:1 propensity score match analysis was performed to compare the short-term effectiveness, the numbers of lymph nodes dissected, and the patterns of recurrence and survival between the two groups.

Results

A total of 294 patients (192 and 102 in the DLT and BB group, respectively) were enrolled in the study. After matching, 204 patients (102 pairs) who underwent one-lung ventilation with DLT or BB displayed no significant variance in baseline characteristics. The BB group had higher number of LNs resected along left RLN (1.8 ± 2.3 vs. 2.5 ± 2.5, P = 0.001). For patients with metastatic left RLN LN, the BB group had longer medium survival time (15 vs. 32 months, P = 0.045), and tended to have longer medium recurrence-free survival time (6 vs. 15 months, P = 0.079), and lower rate of upper mediastinal and cervical LN recurrence (30.00% vs. 66.67%, P = 0.198). The postoperative complications were similar in both groups.

Conclusions

Compared with DLT, using BB in esophagectomy may allow more radical lymphadenectomy along left RLN.

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Availability of data and materials

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Abbreviations

AP:

Artificial pneumothorax

ASA:

American Association of Anesthesiologists

BB:

Bronchial blockers

BMI:

Body mass index

CCI:

Charlson Comorbidity Index

DLT:

Double-lumen tube

LN:

Lymph node

OS:

Overall survival

RLN:

Recurrent laryngeal nerve

VATS:

Video-assisted thoracoscopic surgery

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Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Tongji Hospital Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Wuhan, 430030, China

    De-Hao Tu, Rirong Qu, Wei Ping, Guang Yang, Xiangning Fu & Yixin Cai

  2. Department of Radiology, Tongji Hospital Tongji Medical College Huazhong University of Science and Technology, Wuhan, China

    Xiaoling Ma

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  1. De-Hao Tu
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by all authors. Material analysis was performed by DHT. DHT wrote the manuscript. RQ, WP, GY, XF, and YC participated in revising the manuscript. All authors have read and approved the final manuscript.

Corresponding authors

Correspondence to Xiangning Fu or Yixin Cai.

Ethics declarations

Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board of Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology. All patients signed informed consent.

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Informed consent was obtained from all individual participants included in the study.

Conflict of interests

The authors declare no competing interests.

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Tu, DH., Qu, R., Ping, W. et al. Double-lumen tube versus bronchial blocker in lymphadenectomy along the left recurrent laryngeal nerve for esophageal cancer: a propensity-matched analysis. Langenbecks Arch Surg 407, 1891–1900 (2022). https://doi.org/10.1007/s00423-022-02475-y

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