Jun Liu1,2, Fei Cui1,2, Eugenio Pompeo3, Diego Gonzalez-Rivas4,5, Hanzhang Chen1,2, Weiqiang Yin1,2, Wenlong Shao1,2, Shuben Li1,2, Hui Pan1,2, Jianfei Shen1,2, Lindsey Hamblin1,2, Jianxing He6,2. 1. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. 2. Guangzhou Institute of Respiratory Disease, China State Key Laboratory of Respiratory Disease, Guangzhou, China. 3. Department of Thoracic Surgery, Policlinico Tor Vergata University, Rome, Italy. 4. Minimally Invasive Thoracic Surgery Unit (UCTMI), Coruña, Spain. 5. Department of Thoracic Surgery, Coruña University Hospital, Coruña, Spain. 6. Department of Cardiothoracic Surgery, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China drjianxing.he@gmail.com.
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.
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 NSCLCpatients 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.
Authors: Francisco Lirio; Carlos Galvez; Sergio Bolufer; Juan Manuel Corcoles; Diego Gonzalez-Rivas Journal: J Thorac Dis Date: 2018-08 Impact factor: 2.895