490. THE IMPACT OF ONE-LUNG VENTILATION ON POSTOPERATIVE COMPLICATIONS AFTER IVOR LEWIS ESOPHAGECTOMY

Abstract Background One of the most common issue after Ivor Lewis esophagectomy are pulmonary complications, affecting up to 27% of patients, leading to longer hospital stay and higher healthcare costs. Traditionally, one-lung ventilation (OLV) with a double-lumen tube, is used during the thoracic phase of esophagectomy in order to provide a good surgical view by collapsing the right lung parenchyma. However, OLV has been proven to contribute to negative respiratory outcomes after surgery. On the other hand, a recent metanalysis showed that Two Lung Ventilation (TLV) is feasible throughout the two phases of the procedure, with good clinical, surgical and oncological results. Methods A consecutive series of patients undergoing minimally invasive Ivor Lewis esophagectomy (MIIL) between November 2022 and November 2023 in one high-volume center was retrospectively reviewed. Intraoperative ventilation characteristics were analyzed. Postoperative pulmonary complications were stratified according to Clavien Dindo classification and further divided into mild (<3a) and severe (>3b). Descriptive statistics was used to analyze the study sample. Data was expressed as median and interquartile range (IQR) for non-normally distributed variables and as proportions for binary variables. Categorical variables are expressed as frequencies and analyzed by chi-square (χ2) tests. P-values of < 0.05 defined statistical significance (two-sided). Results Of the 70 patients, 8 were excluded due to lack of data. 62 patients were further stratified into three groups considering the ratio between the durations of OLV and the thoracic phase (OLV/TP): group A less than 25% of OLV/TP, group B more than 25% but less than 75% and group C more than 75%. No difference between the three groups was found in terms of pulmonary complications (χ2=1.6248, p-value=0.4437) whilst patients with a shorter OLV/TP showed a significant reduction in the incidence of severe respiratory complications(χ2= 8.2974, p-value 0.015785, p < 0.05). Conclusion Taking into account the limits of the study (retrospective nature, single center study), our results show that the length of OLV may negatively affect postoperative pulmonary outcomes. These promising results justify the need to conduct a randomized controlled study that would be instrumental in reaching definitive conclusions.