Single-Lumen Tube Intubation with CO2 Insufflation versus Double-Lumen Tube Intubation in Video-Assisted Transthoracic Esophagectomy for Esophageal Cancer: A Retrospective Comparative Study.

Background: Video-assisted transthoracic esophagectomy (VATE) is typically performed with double-lumen tube intubation (DLTI) to facilitate 1-lung ventilation. Single-lumen tube intubation (SLTI) with CO₂ insufflation offers an alternative approach, enabling 2-lung ventilation with artificial pneumothorax, which may improve surgical exposure and reduce pulmonary complications. This study compared the efficacy and safety of SLTI with CO₂ insufflation versus DLTI in VATE.

Methods: This retrospective study included 94 male patients who underwent VATE for esophageal cancer at 108 Military Central Hospital between November 2018 and September 2023. Patients were divided into 2 groups: SLTI with CO₂ insufflation (n=44) and DLTI (n=50). The assessed outcomes included lymph node yield, operative time, postoperative complications, intensive care unit (ICU) admission, and length of hospital stay.

Results: The SLTI group had a significantly higher left recurrent laryngeal nerve lymph node yield (2.22±2.65 vs. 0.77±2.14, p=0.008) and a greater total lymph node harvest (23.91±9.22 vs. 19.00±11.75, p=0.02) than the DLTI group. Operative time was longer in the SLTI group for the thoracic phase (168.64±23.69 minutes vs. 142.12±24.17 minutes, p=0.04) and overall (311.82±43.67 minutes vs. 272.68±35.97 minutes, p=0.001). Postoperative complication rates and length of hospital stay did not differ significantly between groups, although ICU admission was more frequent with SLTI (84.1% vs. 56.0%, p=0.003).

Conclusion: SLTI with CO₂ insufflation is a safe and feasible alternative to DLTI in VATE, enabling more extensive recurrent laryngeal lymph node dissection but requiring longer operative times.