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S. Li



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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
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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)

      16:45 - 18:15  |  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
      25 32 108 87
      0 0 29 8
      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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