Background: No standard procedure exists in respiratory management, including mechanical ventilation, which is commonly administered, after thoracic esophagectomy for esophageal cancer. Methods: Various perioperative clinical parameters and complications were retrospectively compared between the patients who underwent mechanical ventilation (MV group, n = 38) and those who were extubated immediately (immediate extubation: IE group, n = 75), following transthoracic esophagectomy with three-field lymph node dissection (3FLND) for thoracic esophageal cancers. Results: There were no significant differences between the two groups in the early postoperative clinical course. The frequencies of postoperative complications were 39% and 47% in the IE and MV groups, respectively, and pulmonary complications tended to occur more frequently in the MV group (23.7%) than in the IE group (12.0%). Mobilization of the patients was significantly earlier in the IE group than in the MV group (P < 0.0001). Conclusions: IE is feasible and safe even after transthoracic esophagectomy with 3FLND. To avoid the possible disadvantages of MV after surgery, IE can be a standard protocol for postoperative management after transthoracic esophagectomy with radical lymph node dissection.
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