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Ventilatory Requirements Following Esophagectomy: A Comparison Between Open And Minimally Invasive Esophagectomy.
Charles T Bakhos, Jeremiah T. Martin, Alicia A. McKelvey, John A. Federico, Thomas Fabian
Hospital of Saint Raphael, New Haven, CT

Objective: pulmonary complications requiring mechanical ventilation following esophagectomy remain high. In attempts to minimize morbidity and mortality, minimally invasive esophagectomy (MIE) is being used with increasing frequency. We sought to compare ventilatory requirements of patients undergoing MIE and open esophagectomy (OE).

Design: retrospective study.

Setting: community teaching hospital.

Patients: all patients undergoing esophagectomy over a 5-year period (June 2002-March 2007).

Interventions: MIE vs. OE.

Main Outcome Measures: postoperative ventilatory requirements, pulmonary complications, length of stay and mortality.

Results: 37 patients underwent MIE and 38 patients underwent OE. Both groups were comparable with regard to age, diagnosis, comorbidities, and receipt of neoadjuvant therapy. The MIE group was more likely to be extubated in the operating room (83.8% vs. 52.8%, p=0.005). Although not statistically significant, there were trends toward decreased pneumonia rates (6% vs. 21%, p=0.09), decreased reintubation rates (22% vs. 34%, p=0.31) and decreased mortality rates (2.8% vs. 10.5%, p=0.36) in the MIE group compared to the OE group respectively. Median length of stay was 10 days in the MIE group and 11 days in the OE group (p=0.3).

Conclusions: minimally invasive esophagectomy has distinct advantages over an open procedure in terms of early extubation. There appears to be a trend toward fewer reintubations rates and overall ventilatory requirements. MIE may therefore reduce pulmonary morbidity in patients undergoing esophagectomy.

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