McKeown minimally invasive esophagectomy under discontinuous spontaneous ventilating anesthesia by laryngeal mask: a retrospective non-inferiority cohort study.

Background: McKeown minimally invasive esophagectomy (MIE-McKeown) is a safe and feasible surgical method. However, the conventional anesthetic management with endotracheal intubation for MIE-McKeown is associated with high respiratory morbidity. The discontinuous spontaneous ventilating anesthesia by laryngeal mask may have advantages over conventional intubated anesthesia in MIE-McKeown. This study was designed to describe the techniques and evaluate the feasibility of discontinuous spontaneous ventilating anesthesia by laryngeal mask for MIE-McKeown.

Methods: Between October 2022 and September 2024, 33 patients underwent MIE-McKeown at First Affiliated Hospital of Guangzhou Medical University. The study cohort was divided into a discontinuous spontaneous ventilating anesthesia group (Group A) and an intubated anesthesia group (Group B). We retrospectively compared the characteristics and perioperative outcomes of patients who underwent MIE-McKeown.

Results: The clinical characteristics of Group A were not different from Group B except for gender. Non-inferiority analysis demonstrated that in Group A, both the lowest pulse oxygen saturation (SpO₂) and peak end-tidal carbon dioxide (EtCO₂) during cervical and abdominal procedures were non-inferior to those in Group B. Although the peak EtCO₂ during thoracic procedure was significantly higher in Group A than in Group B (57.05±9.12 vs. 45.38±3.97 mmHg, P<0.001), no severe hemodynamic changes, progressive decrease of SpO₂ or requirement conversion to intubated anesthesia were observed. In Group A, pleural effusion occurred in one patient, respiratory failure occurred in one patient. In Group B, and respiratory failure occurred in two patients and paralysis of recurrent laryngeal nerve (RLN) occurred in one patient. There were no cases of perioperative mortality.

Conclusions: The technique of discontinuous spontaneous ventilating anesthesia by laryngeal mask for MIE-McKeown is considered feasible. Careful evaluation of the patients, preoperative assessment and skillful surgical technique are the key factors of successful discontinuous spontaneous ventilating anesthesia by laryngeal mask for MIE-McKeown. The discontinuous spontaneous ventilating anesthesia by laryngeal mask can be a valid alternative to the conventional intubated anesthesia for MIE-McKeown.