The Effect of Combined General Anesthesia and Epidural Analgesia on Postoperative Pulmonary Complications in Thoracoscopic Esophagectomy

<b>Background and Aims:</b> Although combined general anesthesia and epidural analgesia are used in open surgery to promote rehabilitation and expectoration, as well as to prevent postoperative pulmonary complications, their effect in thoracoscopic esophagectomy remains unclear. This study aimed to address this issue. <b>Patients and Methods:</b> We enrolled 150 patients who underwent thoracoscopic esophagectomy between May 2017 and July 2025. Patient characteristics and postoperative outcomes, including maximum numerical rating scale (NRS) after surgery and pneumonia, were compared between the use and non-use of epidural analgesia. Epidural analgesia was not administered in patients using antithrombotic/anticoagulant drugs or in those with a history of thoracic spine surgery. Postoperative analgesia involved the scheduled administration of acetaminophen in all cases, with patient-controlled analgesia using opioids administered to the non-epidural analgesia group. <b>Results:</b> Epidural analgesia was administered to 113 patients (75.3%). The most common levels of epidural catheter placement were Th8/Th9 in 55 patients (36.7%) and Th7/Th8 in 41 patients (27.3%). Laparoscopy was performed in 129 patients (86.0%). Median NRS was five, and pneumonia occurred in 16 patients (10.7%). The epidural anesthesia group had a higher proportion of squamous cell carcinoma (88.5% vs. 73.0%, <i>p</i> = 0.024), lower lymphocyte counts (1680 vs. 2065, <i>p</i> = 0.020), diabetes (16.8% vs. 37.8%, <i>p</i> = 0.007), and hypertension (54.9% vs. 81.1%, <i>p</i> = 0.006), and circular stapler anastomosis (83.2% vs. 62.2%, <i>p</i> < 0.001). No significant differences were observed in the postoperative NRS, pneumonia, or length of postoperative hospital stay. <b>Conclusions:</b> There was no significant difference in the postoperative NRS and pneumonia between those with or without epidural analgesia in thoracoscopic esophagectomy.