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. Methods 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 PPMV (≥ 24 h) and NPMV (< 24 H) groups. The effect of PPMV on OI was analyzed; the number of analyzable cases was expanded to 312, and 95 cases each of PPMV and NPMV were obtained by PSA matching. 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 with PPMV 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 PMS, the difference in AL rate remained significantly (8.42% vs 25.26%, p = 0.002). The pulmonary infection and pleural effusion incidence was lower in PPMV group. Conclusion The sharp decline of OI on POD 2 may cause AL after MIE. Prolonging postoperative mechanical ventilation to 24 hours can moderate the decline of OI and reduce the incidence of anastomotic leakage.