Duration of one-lung ventilation as a risk factor for postoperative pulmonary complications after McKeown esophagectomy

Abstract

Objective: To assess whether the duration of one-lung ventilation (OLV) affects postoperative pulmonary complications after McKeown esophagectomy for esophageal cancer.

Methods: A retrospective analysis of data stored in a database for esophageal cancer was carried out to identify predictors of postoperative pulmonary complications in patients undergoing McKeown esophagectomy at Sun Yat-sen University Cancer Center between 2010 and 2012.

Results: Patients in the OLV ⩾150 minutes group had a higher incidence of postoperative pulmonary complications than those in the OLV <150 minutes group (18.0% vs 7.3%, p < 0.001). Among them, the number of patients who developed pneumonia and atelectasis was also significantly higher (9.0% vs 4.1% [p = 0.031] and 8.7% vs 3.7% [p = 0.018] for the OLV ⩾150 minutes group vs OLV <150 minutes group, respectively). OLV ⩾150 minutes was associated with a prolonged hospital stay (24.2 ± 9.7 vs 21.5 ± 9.2 days, p = 0.001). Multivariate analysis revealed that history of diabetes (odds ratio [OR], 3.56; 95% confidence interval [CI], 1.65-7.68; p = 0.001), chronic obstructive pulmonary disease (OR, 10.65; 95% CI, 5.65-20.08; p < 0.001), and OLV ⩾150 minutes (OR, 3.80; 95% CI, 1.97-7.31; p < 0.001) were independent predictors of postoperative pulmonary complications.

Conclusion: Long duration of OLV appears to be an important risk factor for postoperative pulmonary complications after McKeown esophagectomy. OLV <150 minutes appears to be the better approach for thoracic surgery. Lung protective measures should be taken when prolonged OLV is anticipated.

Keywords: McKeown esophagectomy; One-lung ventilation; postoperative pulmonary complications.