Improvement of surgical complications using single-lumen endotracheal tube intubation and artificial carbon dioxide pneumothorax in esophagectomy: a meta-analysis

Kai-Hao Chuang, Hsing-Hua Lai, Yu Chen, Li-Chun Chen, Hung-I Lu, Yen-Hao Chen, Shau-Hsuan Li, Chien-Ming Lo, Kai-Hao Chuang, Hsing-Hua Lai, Yu Chen, Li-Chun Chen, Hung-I Lu, Yen-Hao Chen, Shau-Hsuan Li, Chien-Ming Lo

Abstract

Background: Esophageal cancer has a poor prognosis. Surgery is the main treatment but involves a high risk of complications. Some surgical strategies have tried to eliminate complications. Our meta-analysis tried to find the benefits of single-lumen endotracheal tube intubation with carbon dioxide (CO2) inflation.

Methods: A systematic search of studies on esophagectomy and CO2 inflation was conducted using PubMed, Medline, and Scopus. The odds ratio of post-operative pulmonary complications and anastomosis leakage were the primary outcomes. The standardized mean difference (SMD) in post-operative hospitalization duration was the secondary outcome.

Results: The meta-analysis included four case-control studies with a total of 1503 patients. The analysis showed a lower odds ratio of pulmonary complications in the single-lumen endotracheal tube intubation in the CO2 inflation group (odds ratio: 0.756 [95% confidence interval, CI: 0.518 to 1.103]) compared to that in the double-lumen endotracheal tube intubation group, but anastomosis leakage did not improve (odds ratio: 1.056 [95% CI: 0.769 to 1.45])). The SMD in hospitalization duration did not show significant improvement. (SMD: -0.141[95% CI: - 0.248 to - 0.034]).

Conclusions: Single-lumen endotracheal tube intubation with CO2 inflation improved pulmonary complications and shortened the hospitalization duration. However, no benefit in anastomosis leakage was observed.

Keywords: Artificial pneumothorax; CO2; Esophagectomy; Video-assisted thoracoscopic surgery.

Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form. The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Preferred reporting items for systematic reviews and meta-analyses (PRISMA) flow diagram for the searching and identification of included studies
Fig. 2
Fig. 2
Pulmonary complications between the DLET group and SLET group, included all studies (a) and excluding Zhang’s series (b)
Fig. 3
Fig. 3
Anastomosis leakage between the DLET group and SLET group, including all studies (a) and excluding Zhang’s series (b)
Fig. 4
Fig. 4
Hospitalization duration between the DLET group and SLET group, including all studies (a) and excluding Zhang’s series (b)
Fig. 5
Fig. 5
Funnel Plot of pulmonary complication studies (a) and hospitalization duration studies (b)

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