Artificial capnothorax versus single-lung ventilation in minimally invasive esophagectomy for esophageal cancer: A randomized controlled trial.
Yi-Min Gu, Yushang Yang, Qixin Shang et al.
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In 30 seconds
This prospective, two-hospital randomized controlled trial compared artificial capnothorax with single-lung ventilation during minimally invasive esophagectomy in 110 patients with resectable esophageal cancer. At three years, overall survival was 65.2% with capnothorax versus 81.6% with single-lung ventilation, and disease-free survival was 61.6% versus 81.6%. Multivariate analyses also associated capnothorax with poorer overall and disease-free survival. The findings suggest less favorable oncological outcomes with capnothorax, although they arise from a trial of limited size.
Key findings
- Incremental circulating tumor cell levels occurred in 18.6% (8/43) with capnothorax and 2.7% (1/37) with single-lung ventilation (P = 0.033).
- Three-year overall survival was 65.2% with capnothorax versus 81.6% with single-lung ventilation (P = 0.049).
- Three-year disease-free survival was 61.6% with capnothorax versus 81.6% with single-lung ventilation (P = 0.019).
- Capnothorax was associated with poorer overall survival (HR: 2.35, 95% CI: 1.05-5.24) and disease-free survival (HR: 2.70, 95% CI: 1.23-5.94) in multivariate analysis.
Why it matters
The ventilation strategy used during minimally invasive esophagectomy may be relevant to both perioperative tumor-cell measurements and longer-term oncological outcomes. In this randomized comparison, survival outcomes favored single-lung ventilation, raising a clinically important question about the oncological safety of capnothorax. The results warrant attention while being interpreted in light of the trial’s size and setting.
What to keep in mind
The trial included 110 patients at two high-volume hospitals, limiting the precision and generalizability of its findings.