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

Surg Endosc. 2023 Mar;37(3):2014-2020. doi: 10.1007/s00464-022-09730-9. Epub 2022 Oct 25.

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.

Keywords: Esophageal cancer; Subcutaneous emphysema; Video-assisted thoracoscopic surgery.

MeSH terms

  • Carbon Dioxide
  • Clinical Relevance
  • Esophageal Neoplasms* / etiology
  • Esophageal Neoplasms* / surgery
  • Humans
  • Lung Neoplasms* / surgery
  • Pneumothorax* / etiology
  • Pneumothorax* / surgery
  • Postoperative Complications / etiology
  • Retrospective Studies
  • Subcutaneous Emphysema* / etiology
  • Thoracic Surgery, Video-Assisted / adverse effects
  • Thoracic Surgery, Video-Assisted / methods

Substances

  • Carbon Dioxide