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Related Experiment Video

Updated: Jan 16, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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Prolonged postoperative mechanical ventilation is associated with a decrease in anastomotic leak following

Liang Zhang1, Shulin Zhao2, Taiming Zhang1

  • 1Department of Thoracic Surgery, Daping Hospital, Army Medical University, Changjiang Route 10#, Daping, Chongqing, 400042, People's Republic of China.

Surgical Endoscopy
|October 3, 2025
PubMed
Summary

Prolonging postoperative mechanical ventilation (PPMV) after minimally invasive esophagectomy may reduce anastomotic leaks by moderating oxygenation index decline. This strategy shows promise for improving patient outcomes and reducing complications.

Keywords:
Anastomotic leakMinimally invasive esophagectomyOxygenation indexPostoperative mechanical ventilation

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Area of Science:

  • Surgical Oncology
  • Critical Care Medicine
  • Respiratory Physiology

Background:

  • Anastomotic leak (AL) is a serious complication following minimally invasive esophagectomy (MIE).
  • The role of oxygen therapy in preventing AL after MIE remains unclear.
  • Optimal timing and methods for oxygen therapy require further investigation.

Purpose of the Study:

  • To investigate the relationship between oxygenation index (OI) trends and anastomotic leak (AL) after MIE.
  • To evaluate the impact of prolonged postoperative mechanical ventilation (PPMV) on OI and AL incidence.
  • To compare AL rates and other complications between PPMV and non-prolonged postoperative mechanical ventilation (NPMV) groups.

Main Methods:

  • Retrospective analysis of OI in 75 patients undergoing MIE for esophageal cancer.
  • Categorization into PPMV (≥24h) and NPMV (<24h) groups based on ventilation duration.
  • Propensity Score Matching (PSM) applied to compare AL incidence and complications in 89 matched pairs.

Main Results:

  • OI significantly decreased on postoperative days 1 and 2, with a more pronounced drop in the AL group on day 2.
  • Patients in the PPMV group experienced a moderate OI decrease and a significantly lower AL rate (8.08% vs 23.47%, p=0.001).
  • PSM confirmed the reduced AL rate in the PPMV group (7.88% vs 24.71%, p=0.004), along with lower incidences of pulmonary infection and pleural effusion.

Conclusions:

  • A sharp decline in OI on postoperative day 2 may contribute to AL after MIE.
  • Prolonging postoperative mechanical ventilation to 24 hours may mitigate OI decline.
  • PPMV appears to be a potentially effective strategy for reducing anastomotic leakage and associated complications after MIE.