Major lung resections with spontaneous ventilation: a narrative review

Abstract

In the last decades, technical improvements and the advance of innovative technologies have made thoracic surgery increasingly less invasive: video-assisted thoracic surgery (VATS) is now considered the best approach for early-stage non-small cell lung cancer (NSCLC) surgical treatment, and has become the first choice for many non-oncological thoracic diseases requiring surgery, with proved advantages in terms of less post-operative pain, fewer complications and a faster recovery. Combining minimally invasive surgical and anaesthetic techniques is one of the new frontiers of thoracic surgery: in this scenario nonintubated thoracic surgery (NITS) is a promising approach to minimize risks related to general anaesthesia and intubation, promote a faster recovery and reduce hospital stay. Since its first reported applications for minor thoracic procedures in the late 90s, NITS has emerged as a promising technique and it is recently being applied also to technical demanding major thoracic anatomical resections, such as lobectomies and segmentectomies, with encouraging results concerning feasibility, perioperative outcomes and complication rates. The oncological value of NITS is also being explored: recent studies show better compliance with adjuvant chemotherapy protocols and fewer events of toxicity in patients treated with NITS procedures. The aim of this narrative review is to investigate the role of NITS applied to major lung resections in terms of feasibility, short-term outcomes and applications in everyday clinical practice.