Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis

Wang, Manling; How, Cheng‐Hung; Hung, Ming-Hui; Huang, Hui-Hsun; Hsu, Hsao-Hsun; Cheng, Ya-Jung; Chen, Jin‐Shing

doi:10.1016/j.jfma.2021.04.018

Cited by 15 publications

(15 citation statements)

References 27 publications

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“…This propensity-matched case study confirmed that non-intubated thoracoscopic surgery is associated with similar OS and RFS rates in elderly patients aged ≥75 years with pathologically proven NSCLC. Compared to the intubated group, the non-intubated group showed satisfactory perioperative results, as in previous studies ( 9 , 11 , 13 – 15 ). Although there were fewer lymph nodes harvested in the non-intubated group, it did not influence the long-term results compared to the intubated group.…”

Section: Discussionsupporting

confidence: 82%

“…To date, few studies have focused on the survival of patients undergoing non-intubated thoracoscopic surgeries. Wang et al conducted an analysis of patients with early-stage disease who underwent lobectomy ( 11 ). The results showed similar OS and RFS rates for non-intubated and intubated lobectomy.…”

Section: Discussionmentioning

confidence: 99%

“…The anesthesia techniques used herein have been described previously ( 9 , 11 , 12 ). Sedation was performed using intravenous administration of propofol (10 mg/mL) followed by intravenous fentanyl (0.5–2 µg/kg) or rocuronium (0.6 mg/kg).…”

Section: Methodsmentioning

confidence: 99%

“…The monitor system was similar as that for the non-intubated patients ( 9 , 11 ). Anesthesia was induced by the intravenous administration of the propofol, thiopental (3–5 mg/kg), rocuronium (0.6 mg/kg), or fentanyl.…”

Section: Methodsmentioning

confidence: 99%

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Non-Intubated Versus Intubated Video-Assisted Thoracic Surgery in Patients Aged 75 Years and Older: A Propensity Matching Study

Chen

Chuang

et al. 2022

Front. Surg.

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IntroductionIn most developed countries, lung cancer is associated with the highest mortality rate among all cancers. The number of elderly patients with lung cancer is increasing, reflecting the global increase in aging population. Patients with impaired lung or cardiac function are at a high risk during intubated general anesthesia, which may preclude them from surgical lung cancer treatment. We evaluated the safety and survival of non-intubated video-assisted thoracoscopic surgery (VATS) versus those of intubated thoracoscopic surgery for surgical resection for lung cancer in older patients.MethodsPatients aged ≥75 years who underwent non-intubated and intubated VATS resection with pathologically confirmed non-small cell lung cancer, using a combination of thoracic epidural anesthesia or intercostal nerve block and intra-thoracic vagal block with target-controlled sedation, from January 2011 to December 2019 were included. Ultimately, 79 non-intubated patients were matched to 158 patients based on age, sex, body mass index, family history, comorbidity index, pulmonary function (forced expiratory volume in one second/ forced vital capacity [%]), and disease stage. The endpoints were overall survival and recurrence progression survival.ResultsAll patients had malignant lung lesions. Data regarding conversion data and the postoperative result were collected. Both groups had comparable preoperative demographic and cancer staging profiles. The anesthetic duration in the non-intubated group was shorter than that in the intubated group, which showed a significantly higher mean number of lymph nodes harvested (intubated vs non-intubated, 8.3 vs. 6.4) and lymph stations dissected (3.0 vs. 2.6). Intensive care unit (ICU) admission rate and postoperative ICU stay were significantly longer in the intubated group. The complication rate was higher and hospital stay were longer in the intubated group, but these differences were not significant (12% vs. 7.6%; p = .07, respectively).ConclusionsIn the elderly, non-intubated thoracoscopic surgery provides similar survival results as the intubated approach, although fewer lymph nodes are harvested. Non-intubated surgery may serve as an alternative to intubated general anesthesia in managing lung cancer in carefully selected elderly patients with a high risk of impaired pulmonary and cardiac function.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Non-Intubated Versus Intubated Video-Assisted Thoracic Surgery in Patients Aged 75 Years and Older: A Propensity Matching Study

Chen

Chuang

et al. 2022

Front. Surg.

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“…In another study, the overall survival and disease-free survival after lung cancer surgery were significantly better after sOLV than after mOLV, with type of anesthesia being an independent factor for both overall and disease-free survival in patients who had spontaneous ventilation ( 33 ). However, another study demonstrated no significant difference in disease recurrence and survival between the sOLV and mOLV methods ( 34 ). Meanwhile, a study on awake breast cancer surgery suggested that both extrathoracic cancer cases and lung cancer sOLV cases had shorter operative time and length of hospital stay ( 35 , 36 ).…”

Section: Effects Of Nits On Cancermentioning

confidence: 99%

Pathophysiological Advantages of Spontaneous Ventilation

et al. 2022

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Surgical procedures cause stress, which can induce an inflammatory response and reduce immune function. Following video-assisted thoracoscopic surgery (VATS), non-intubated thoracic surgery (NITS) was developed to further reduce surgical stress in thoracic surgical procedures. This article reviews the pathophysiology of the NITS procedure and its potential for reducing the negative effects of mechanical one-lung ventilation (mOLV). In NITS with spontaneous ventilation, the negative side effects of mOLV are prevented or reduced, including volutrauma, biotrauma, systemic inflammatory immune responses, and compensatory anti-inflammatory immune responses. The pro-inflammatory and anti-inflammatory cytokines released from accumulated macrophages and neutrophils result in injury to the alveoli during mOLV. The inflammatory response is lower in NITS than in relaxed-surgery cases, causing a less-negative effect on immune function. The increase in leukocyte number and decrease in lymphocyte number are more moderate in NITS than in relaxed-surgery cases. The ventilation/perfusion match is better in spontaneous one-lung ventilation than in mOLV, resulting in better oxygenation and cardiac output. The direct effect of relaxant drugs on the acetylcholine receptors of macrophages can cause cytokine release, which is lower in NITS. The locoregional anesthesia in NITS is associated with a reduced cytokine release, contributing to a more physiological postoperative immune function.

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Simultaneous thoracoscopic surgery in patients with atrial fibrillation and early-stage lung cancer

Jiang,

Zhang,

Ding

et al. 2024

International Journal of Cardiology

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Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis

Cited by 15 publications

References 27 publications

Non-Intubated Versus Intubated Video-Assisted Thoracic Surgery in Patients Aged 75 Years and Older: A Propensity Matching Study

Non-Intubated Versus Intubated Video-Assisted Thoracic Surgery in Patients Aged 75 Years and Older: A Propensity Matching Study

Pathophysiological Advantages of Spontaneous Ventilation

Simultaneous thoracoscopic surgery in patients with atrial fibrillation and early-stage lung cancer

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