The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer: a propensity score matching analysis

Abstract

Objectives: To comparatively assess the impact of non-intubated intravenous anaesthesia with spontaneous ventilation (NIIASV) versus intubated anaesthesia with single-lung mechanical ventilation (IASLV) on early outcomes of video-assisted thoracoscopic (VATS) anatomical resection of non-small-cell lung cancer (NSCLC).

Methods: A total of 339 patients with NSCLC undergoing VATS anatomical resection (282 lobectomies and 57 segmentectomies) between December 2011 and December 2014 were included for analysis and divided into two groups according to anaesthesia type: NIIASV (151 patients) and IASLV (188 patients). Comprehensive early outcome data including intraoperative and postoperative variables were compared between subgroups. Propensity score matching was used to control for selection bias due to non-random group assignment in a 1:1 manner, resulting in 136 pairs (20 for segmentectomy and 116 for lobectomy) with balanced baseline characteristics.

Results: The NIIASV procedure was completed uneventfully in all 32 patients undergoing segmentectomy and in 119 lobectomy patients undergoing lobectomy, whereas 9 lobectomy patients required conversion to IASLV. These 9 cases were excluded from the comparative analysis. Comparisons between NIIASV and IASLV results showed no intergroup differences in demographics, baseline data, operative time, intraoperative blood loss, number of resected lymph nodes and duration of chest tube dwell time. Conversely, significantly better results occurred in the NIIASV group in postoperative fasting time (P < 0.001), overall postoperative chest drainage volume (P < 0.04) and hospital stay (P < 0.02).

Conclusions: In this study, VATS anatomical resection for NSCLC patients is feasible under NIIASV. Perioperative data comparisons with IASLV have shown that postoperative fasting time, overall drainage volume and hospital stay were significantly better with NIIASV, suggesting a more rapid recovery. Further investigation is warranted to assess the long-term effects and survival of this promising globally less invasive surgical strategy.

Keywords: Intravenous anaesthesia with spontaneous ventilation; Lobectomy; Lymph node dissection; NSCLC; Non-intubated VATS; Non-intubated thoracic surgery; Segmentectomy.