Immediate extubation after esophagectomy with three-field lymphadenectomy enables early ambulation in patients with thoracic esophageal cancer

Abstract

Background: We retrospectively compared the effects of immediate extubation (IE) in the operating room with those of overnight mechanical ventilation (MV) after radical transthoracic esophagectomy with 3-field lymphadenectomy in patients with thoracic esophageal cancer. Methods: A total of 96 patients were evaluated. 48 patients were extubated in the operating room after surgery (IE group). The other 48 patients were extubated on the following morning (MV group). The propensity score-matching method was used to assemble a well-balanced cohort. Clinical and postoperative outcomes were investigated in each group. We also compared postoperative laboratory parameters between groups. Results: The rate of ambulation on postoperative day (POD) 1 was significantly higher in the IE group compared with that in the MV group (50 vs 19%, respectively, p = 0.003). Moreover, the rate of catecholamine use in the ICU was significantly lower in the IE group compared with that in the MV group (15 vs 65%, respectively, p < 0.001). With regard to postoperative respiratory management, there were no significant differences between groups. The length of ICU stay after esophagectomy was significantly shorter in the IE group compared with that in the MV group (p = 0.01), whereas the length of postoperative hospital stay was similar between groups (p = 0.265). There were also no significant differences in the incidence of postoperative complications. Conclusions: IE in the operating room is not only safe and feasible, even after transthoracic esophagectomy with radical 3-field lymphadenectomy, but also contributes to decrease in catecholamine use, to increase in ambulation on POD 1 and to shorten the ICU stay.