One-Lung Ventilation Duration Is a Risk Factor for Pneumonia in Minimally Invasive and Robotic Esophagectomy.

Introduction: Postoperative pulmonary complications, particularly pneumonia, remain frequent after esophagectomy and contribute significantly to morbidity. One-lung ventilation (OLV) is a potential modifiable risk factor, but its impact in minimally invasive (MIE) and robot-assisted Ivor Lewis esophagectomy (RAMIE) within European populations is not well defined. Methods: 619 patients undergoing MIE or RAMIE were analyzed. OLV duration was extracted from operative records. Postoperative pneumonia incidence, overall survival, and perioperative outcomes were assessed. ASA classification and other risk factors were considered. Results: The overall incidence of postoperative pneumonia was 18.6%, with no significant difference between MIE (20.4%) and RAMIE (18.2%). Prolonged OLV duration increased pneumonia risk by 4% per 10 min. Female sex and higher ASA classification were also significant risk factors. Likely reflecting early diagnosis and advanced perioperative management, pneumonia did not affect overall survival, which remained comparable between MIE and RAMIE. Conclusions: Prolonged OLV during MIE and RAMIE increases the risk of postoperative pneumonia without significantly affecting overall survival, reflecting effective complication management. OLV duration may serve as a practical intraoperative indicator to guide risk stratification and optimize postoperative care in minimally invasive and robot-assisted Ivor Lewis esophagectomy.