Prolonged postoperative mechanical ventilation is associated with a decrease in anastomotic leak following esophagectomy.

Background: Anastomotic leak (AL) is a severe complication after minimally invasive esophagectomy (MIE). Oxygen therapy is expected to reduce its incidence. However, when and how to conduct oxygen therapy and whether it reduces anastomotic leak incidence is unclear.

Method: We retrospectively analyzed the oxygenation index (OI) of 75 patients with esophageal cancer after MIE in our hospital. Trends of OI changes were depicted. According to mechanical ventilation duration, patients were divided into Prolonged Postoperative Mechanical Ventilation (PPMV) (≥ 24 h) and Non-Prolonged Postoperative Mechanical Ventilation (NPMV) (< 24 h) groups. The effect of PPMV on OI was analyzed; the number of analyzable cases was expanded to 312, and 89 cases each of PPMV and NPMV were obtained by Propensity Score Matching (PSM). The incidences of AL and other complications were compared between the two groups.

Results: OI significantly decreased on POD1 and 2. OI in AL group was higher on POD1 and showed a more dramatic decrease on POD 2. Patients in PPMV group had a moderate OI decrease on POD 2 and lower AL rate. Expanding cases to 312, AL rate in PPMV group was significantly lower than NPMV group (8.08% vs 23.47%, p = 0.001). After PSM, the difference in AL rate remained significant (7.88% vs 24.71%, p = 0.004). The pulmonary infection and pleural effusion incidence was lower in PPMV group.

Conclusion: The sharp decline of OI on POD 2 may cause AL following MIE. Prolonging postoperative mechanical ventilation to 24 h may help moderate the decline in OI and potentially reduce the incidence of anastomotic leakage.