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W. Yin
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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
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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): W. Yin
- Abstract
- Presentation
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
Table2. Operative resultsSegmentectomy 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 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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