Duration of one-lung ventilation stage, POSSUM value and the quality of post-operative analgesia significantly affect survival and length of stay on intensive care unit of patients undergoing two-stage esophagectomy

PURPOSE: To analyze different factors affecting the outcome of patients undergoing Two Stage Esophagectomy (TSE) for the treatment of esophageal carcinoma (EC) while relating these factors to the length of stay on Intensive Care Unit (ILOS), mortality, and morbidity. METHODS: Retrospective study of case-notes of 45 patients who underwent a TSE for resection of EC at a general district hospital in the United Kingdom (UK). These procedures were performed by the same surgical team and followed same approach, known as the Ivor-Lewis procedure. RESULTS: The duration of One Lung Ventilation (OLV) during TSE was found to be critical for patient's outcome. Statistical analysis suggested a potentially strong effect of the duration of OLV (range: 90-320 minutes) on the ILOS (P=0.001). The ratio OLV: Total duration of surgery (TOT) was significantly different in early post-operative (PO) deaths (within 3 months) and late deaths after the third month (P=0.032). The POSSUM value (Physiological and Operative Severity Score for Enumeration of Mortality) correlated well with ILOS (P=0.05). Regression analysis showed a strong relationship between the two variables (P=0.03). An excellent to good quality of PO analgesia allowed for shorter ILOS (P=0.023). CONCLUSIONS: Duration of the OLV appears as an important factor in the outcome of patients. POSSUM value could help in planning the post-operative critical care need of patients undergoing TSE. A well managed post-operative pain allowed to reduce the ILOS.