Comparison of Respiratory function recovery after esophagectomy: a retrospective analysis of surgical approaches.

BACKGROUND: Esophagectomy for patients with esophageal cancer is a highly invasive procedure that can lead to substantial postoperative pulmonary impairment. Minimally invasive approaches, such as video-assisted thoracoscopic surgery (VATS) and robot-assisted minimally invasive esophagectomy (RAMIE), have been introduced to improve postoperative outcomes. This study aimed to assess the impact of surgical approach on postoperative pulmonary function recovery. METHODS: A retrospective analysis was conducted on patients who underwent esophagectomy between 2006 and 2023. Patients were categorized into three groups: open esophagectomy (OE), VATS, and RAMIE. Pulmonary function was assessed using vital capacity (VC) and forced expiratory volume in one second (FEV1.0) at one, three, six, and 12 months postoperatively. Multivariate logistic regression was performed to identify independent factors influencing respiratory function decline. RESULTS: In all approaches, the VC and FEV1.0 decreased at one month postoperatively, followed by gradual recovery. Compared with OE, RAMIE showed a significantly better VC than OE at one month postoperatively (p = 0.04), whereas VATS showed a significantly better FEV1.0 at one month (p = 0.03). By 12 months, respiratory function recovery was comparable among all groups. Postoperative pulmonary complications (PPCs) were identified as a significant risk factor for long-term pulmonary function decline (p = 0.044). CONCLUSIONS: Minimally invasive approaches, particularly RAMIE and VATS, contribute to preserving postoperative respiratory function at one month. However, respiratory function recovery is similar across all surgical techniques at one year. Preventing PPCs is crucial for improving respiratory function outcomes. Further prospective studies are needed to validate these findings and refine surgical strategies.