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Clinical significance of postoperative subcutaneous emphysema after video-assisted thoracoscopic surgery for esophageal cancer

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Abstract

Background

Postoperative subcutaneous emphysema (SE) is a possible complication of thoracoscopic or laparoscopic surgery. This study investigated the risk factors and clinical significance of SE after video-assisted thoracoscopic surgery for esophageal cancer (VATS-e).

Methods

This study included 135 patients who underwent VATS-e with artificial CO2 pneumothorax. Based on the X-ray images on the first postoperative day, patients were divided into two groups: N/L group (no SE or SE localized at the thoracic area, n = 65) and SE group (SE extended to the cervical area, n = 70). We compared clinicopathological features, surgical findings, and short-term outcomes between the two groups.

Results

In SE group, there were more patients who received neoadjuvant chemotherapy compared to N/L group. SE group had significantly lower preoperative body mass index. SE group had more frequently two-lung ventilation than N/L group. Multivariate analysis demonstrated that low BMI, NAC, and two-lung ventilation were independent risk factors for SE extended to the cervical area. Although pulmonary complication was relatively frequent in SE group, there were no significant differences in surgical outcomes between two groups, and all patients had SE disappeared within 21 days without serious complications.

Conclusions

Despite extension to the cervical area, SE had a modest impact on the short-term result of VATS-e with artificial CO2 pneumothorax.

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Acknowledgements

The authors would like to thank Enago (www.Enago.jp) for English language review.

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Authors and Affiliations

  1. Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan

    Takafumi Suzuki, Yusuke Ishibashi, Hironori Tsujimoto, Hidekazu Sugasawa, Kotaro Wakamatsu, Keita Kouzu, Yujiro Itazaki, Takao Sugihara, Manabu Harada, Nozomi Ito, Yoji Kishi & Hideki Ueno

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  1. Takafumi Suzuki
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  2. Yusuke Ishibashi
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  3. Hironori Tsujimoto
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  4. Hidekazu Sugasawa
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  7. Yujiro Itazaki
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  9. Manabu Harada
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  10. Nozomi Ito
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  12. Hideki Ueno
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Contributions

TS, YI, and HT contributed to the study conception and design. YI, KK, TS, MH, NI, HS, and KW contributed to the analysis and interpretation of data. HT, YK, and HU provided supervision of the critical revision of the article.

Corresponding author

Correspondence to Hironori Tsujimoto.

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Disclosures

All authors (Takafumi Suzuki, Yusuke Ishibashi, Hironori Tsujimoto, Hidekazu Sugasawa, Kotaro Wakamatsu, Keita Kouzu, Yujiro Itazaki, Takao Sugihara, Manabu Harada, Nozomi Ito, Yoji Kishi, and Hideki Ueno) declare that they have nothing to disclose in this manuscript.

Human rights statement

This study was conducted in accordance with the World Medical Association Declaration of Helsinki.

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Informed consent or substitute for it was obtained from all patients for being included in the study.

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Suzuki, T., Ishibashi, Y., Tsujimoto, H. et al. Clinical significance of postoperative subcutaneous emphysema after video-assisted thoracoscopic surgery for esophageal cancer. Surg Endosc 37, 2014–2020 (2023). https://doi.org/10.1007/s00464-022-09730-9

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