Single-Lumen Tube Intubation with CO2 Insufflation versus Double-Lumen Tube Intubation in Video-Assisted Transthoracic Esophagectomy for Esophageal Cancer: A Retrospective Comparative Study.

BACKGROUND

Video-assisted transthoracic esophagectomy (VATE) is typically performed with double-lumen tube intubation (DLTI) to facilitate 1-lung ventilation. Single-lumen tube intubation (SLTI) with CO2 insufflation offers an alternative approach, enabling 2-lung ventilation with artificial pneumothorax, which may improve surgical exposure and reduce pulmonary complications. This study compared the efficacy and safety of SLTI with CO2 insufflation versus DLTI in VATE.

METHODS

This retrospective study included 94 male patients who underwent VATE for esophageal cancer at 108 Military Central Hospital between November 2018 and September 2023. Patients were divided into 2 groups: SLTI with CO2 insufflation (n=44) and DLTI (n=50). The assessed outcomes included lymph node yield, operative time, postoperative complications, intensive care unit (ICU) admission, and length of hospital stay.

RESULTS

The SLTI group had a significantly higher left recurrent laryngeal nerve lymph node yield (2.22±2.65 vs. 0.77±2.14, p=0.008) and a greater total lymph node harvest (23.91±9.22 vs. 19.00±11.75, p=0.02) than the DLTI group. Operative time was longer in the SLTI group for the thoracic phase (168.64±23.69 minutes vs. 142.12±24.17 minutes, p=0.04) and overall (311.82±43.67 minutes vs. 272.68±35.97 minutes, p=0.001). Postoperative complication rates and length of hospital stay did not differ significantly between groups, although ICU admission was more frequent with SLTI (84.1% vs. 56.0%, p=0.003).

CONCLUSION

SLTI with CO2 insufflation is a safe and feasible alternative to DLTI in VATE, enabling more extensive recurrent laryngeal lymph node dissection but requiring longer operative times.