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Two-lung ventilation or one-lung ventilation for esophagectomy: maybe the more is better from the evidence of meta-analysis

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Abstract

One-lung ventilation (OLV) is the most commonly used ventilation strategy during esophagectomy. However, two-lung ventilation (TLV) with artificial pneumothorax has been applied in recent years during esophagectomy. It is unclear whether TLV takes advantages over OLV for esophagectomy. Here, we conducted a meta-analysis to compare the effects of TLV and OLV for esophagectomy. We searched relevant studies from the Cochrane Central Register of Controlled Trials, Pubmed, and Embase in November 2020. We included studies that compared the effects of TLV with OLV in esophagectomy and provided sufficient perioperative and postoperative data. We extracted data of postoperative outcomes (postoperative pulmonary complications, anastomotic leak, hospital stay) and surgical variables (thoracic phrase time, blood loss, the number of total resected thoracic lymph nodes). We calculated the risk ratio (RR) for dichotomous data and the weighted mean differences (WMDs) for continuous data. Six studies with 1725 patients were included in this meta-analysis. TLV was associated with significantly lower incidence of postoperative pulmonary complications [RR = 0.714; 95% confidence interval (CI) = (0.534, 0.956); P = 0.023], shorter hospital stay [WMD =  − 0.148; 95% CI = (− 0.246, − 0.051); P = 0.003], less blood loss [WMD =  − 0.352; 95% CI = (− 0.528, − 0.176); P < 0.001] and more resected thoracic lymph nodes [WMD = 0.207; 95% CI = (0.003, 0.4120); P = 0.047] than OLV. Moreover, TLV consumed similar time for thoracic phrase [WMD =  − 0.289; 95% CI = (− 0.661, 0.083); P = 0.128], and yielded a comparable rate of anastomotic leak [RR = 1.086; 95% CI = (0.842, 1.400); P = 0.525] compared with OLV. TLV with artificial pneumothorax resulted in less trauma than OLV. TLV with artificial pneumothorax is safe and could be a choice of ventilation strategy for esophagectomy.

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Author notes

  1. Han-Yu Deng, Yuhan Zhang, and Ying Ren contributed equally to the study and shared the co-first authorship.

Authors and Affiliations

  1. Lung Cancer Center, West China Hospital, Sichuan University, No. 37 Guoxue Street, Chengdu, 610041, Sichuan, China

    Han-Yu Deng & Xiaojun Tang

  2. Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, 610041, China

    Yuhan Zhang & Yi Xu

  3. Department of Outpatient, West China Hospital, Sichuan University, Chengdu, 610041, China

    Ying Ren

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  1. Han-Yu Deng
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Contributions

H-YD, YZ, and Ying Ren collected data and drafted the manuscript. YZ and YX analyzed the data under H-YD designed the study and revised the manuscript. All authors read and approved the final manuscript.

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Correspondence to Han-Yu Deng or Xiaojun Tang.

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Ethical approval

Our study was approved by the Ethics Committee of West China Hospital, Sichuan University (No. 20201101). 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.

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13304_2022_1269_MOESM1_ESM.tif

Supplementary file1 Supplementary Fig. 1. the sensitivity analysis based on postoperative pulmonary complications (a), hospital stay (b), anastomotic leak (c), thoracic phrase time (d), blood loss (e) and number of total resected thoracic lymph nodes (f). (TIF 1866 KB)

Supplementary file2 Supplementary Fig. 2. The funnel pot of publication bias tested by Begg’s test. (TIF 5046 KB)

Supplementary file3 (DOCX 15 KB)

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Deng, HY., Zhang, Y., Ren, Y. et al. Two-lung ventilation or one-lung ventilation for esophagectomy: maybe the more is better from the evidence of meta-analysis. Updates Surg 74, 1199–1207 (2022). https://doi.org/10.1007/s13304-022-01269-7

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  • DOI: https://doi.org/10.1007/s13304-022-01269-7

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