Author of

• 15832

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  ORAL 35 - Surgical Approaches in Localized Lung Cancer (ID 155)

  • Event: WCLC 2015
  • Type: Oral Session
  • Track: Treatment of Localized Disease - NSCLC
  • Presentations: 1
  • Moderators:M. de Perrot, J. Mitchell
  • Coordinates: 9/09/2015, 16:45 - 18:15, 601+603

  • 15839

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    ORAL35.07 - The Feasibility and Safety of Complete VATS for NSCLC Under Non-Intubated Intravenous Anesthesia in Comparison with Intubated Anesthesia (ID 1680)

    17:50 - 18:01  |  Author(s): S. Li
    • Abstract
    • Presentation
    • Slides

    Background:
    General anesthesia with intubated ventilation is the standard in thoracic surgery. However, intubated anesthesia is often associated with postoperative discomfort and related complications. Recently, non-intubated anesthesia has emerged as a new option, but has only been assessed by several small-size reports. This study is to evaluate the feasibility and safety of non-incubated video-assissted thoracic surgery (VATS) for NSCLC under combined intravenous anesthesia (spontaneous respiratory status) and to compare it with the endotracheal intubated anesthesia.
    
    Methods:
    We retrospectively collected all NSCLC cases who underwent complete VATS lobectomy or segmental resection in our center under either non-intubated or intubated anesthesia. In this study, all non-intubated anesthesia cases were performed under combined intravenous anaesthetics plus analgesics while the intubated anesthesia cases were performed using double lumen endotracheal anesthesia. All procedures were conducted by the same group of surgeons and anesthesiologists from Dec 2011 to Dec 2014. Intra-operative and post-operative outcomes were compared between the two groups.
    
    Results:
    A total of 156 non-intubated and 188 intubated cases were included for analyses (Table 1). All non-intubated segment resections and the majority of non-intubated lobectomies were well exposed and were successfully completed; only 9 non-intubated cases planned for lobectomy (9/115, 7.2%) switched to intubated anesthesia. As shown in Table 2, both non-incubated lobectomy and segmentectomy had comparable outcomes with intubated anesthesia, regarding surgical duration, intraoperative blood loss, etc., as well as post-operative complications. Potential advantages were observed when comparing post-operative feeding time, volume of postoperative pleural drainage, and duration of post-operative hospital stay. Table1. Patient Demographics and Baseline Characteristics

    		Segmentectomy			Lobectomy
    	Intubated	Non-intubated	P- value	Intubated	Non-intubated	P- value
    Age (years)	56.5±12.3	51.2±11.8	0.115	58.9±11.7	56.5±10.3	0.179
    Sex(male,%)	11(44%)	12(35.3%)	0.087	97（58.4%）	64（55.2%）	0.215
    Smoking	5(25)	7（20.6%）	0.161	21（12.7%）	15（13.0%）	0.679
    BMI(kg/m2)	22.7±3.1	22.1±2.2	0.412	23.0±3.5	22.6±2.5	0.316
    Tumor size	1.2±0.6	1.0±0.4	0.255	2.9±1.5	2.4±1.4	0.207
    stage
    Ⅰ	25	32		108	87
    Ⅱ	0	0	29	8
    Ⅲ	0	0	26	20

    Table2. Operative results

    		Segmentectomy			Lobectomy
    	Intubated	Non-intubated	P- value	Intubated	Non-intubated	P- value
    Surgical duration(min)	149.8±38.7	157.4±40.5	0.483	186.5±57.5	186.1±56.6	0.730
    Intraoperative blood loss (mL)	83.6±64.1	73.9±56.5	0.076	154.7±258.3	130.8±185.7	0.165
    Conversion to intubation		0			9
    Postoperative feeding time (h)	13.9±4.6	7.6±3.2	<0.001	12.9±2.2	7.2±2.5	<0.001
    Volume of pleural drainage (mL)	694.8±768.2	486.9±313.8	0.038	817.7±727.2	647.7±402.0	0.023
    Chest-tube dwell time (days)	4.0±6.5	2.9±2.5	0.148	3.6±2.5	3.1±1.7	0.321
    Duration of postoperative hospital stay (days)	9.5±7.4	7.1±3.5	0.041	8.8±4.1	7.6±2.4	0.044
    Number of dissected lymph nodes	6.6±4.7	9.5±6.2	0.408	16.5±9.4	17.1±9.0	0.574
    Stations of dissected lymph nodes	2.7±3.5	3.5±1.0	0.526	4.5±1.1	4.6±1.0	0.619

    
    
    Conclusion:
    This large comparative study demonstrated that complete VATS for resection of NSCLC under non-intubated anesthesia is feasible and safe. Non-intubated anesthesia is comparable to intubated approaches, and might have advanteages in terms of post-operative rehabilitation. However, the comparison regarding the long-term outcome is warranted.
    
    

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