Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy

Int J Mol Sci. 2017 Jul 7;18(7):1466. doi: 10.3390/ijms18071466.


Background: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia.

Methods: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery.

Results: The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure (p = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 (p = 0.03), 7 (p = 0.04), and 14 (p = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) (p = 0.04). The median hospital stay was 3.0 vs. 3.7 (p = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay.

Conclusions: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.

Keywords: lung metastases; non-intubated surgery; video-assisted thoracic surgery.

MeSH terms

  • Aged
  • Female
  • Humans
  • Inflammation / immunology*
  • Inflammation / pathology
  • Interleukin-6 / metabolism
  • Intubation
  • Killer Cells, Natural / immunology
  • Lung Neoplasms / secondary*
  • Lung Neoplasms / surgery*
  • Male
  • Metastasectomy*
  • Middle Aged
  • Morbidity
  • Postoperative Care


  • Interleukin-6