Short-term efficacy of non-intubation anesthesia in thoracoscopic lobectomy for lung cancer: a systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Xiaofan , SUN Qingchao , LI Desheng ,  ZHANG Liwei

Department of Thoracic Surgery, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, P. R. China;

Corresponding author：

ZHANG Liwei, Email: zhangliweixj@163.com

Keywords：

Thoracoscopic lobectomy; non-tracheal intubation anesthesia; enhanced recovery aftersurgery; postoperative complication management; randomized controlled trial; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202305042

Video：

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Objective To compare the postoperative enhanced recovery outcomes of lobectomy performed under non-intubated video-assisted thoracic surgery (NIVATS) versus intubated video-assisted thoracic surgery (IVATS). Methods Computerized searches were performed in the following databases: China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP Information, China Biomedical Literature Database (CBMdisc), Web of Science, Clinicaltrials.gov, The Cochrane Library, EMbase, and PubMed. We collected randomized controlled trials (RCTs) and observational studies comparing NIVATS and IVATS. The search period extended from the inception of each database to April 1, 2023. Two independent researchers screened the literature and assessed study quality. Results A total of 14 studies were included, comprising 4 randomized controlled trials and 10 retrospective cohort studies, involving 1 840 patients. Meta-analysis results indicated that, compared to IVATS, NIVATS was associated with significantly shorter operative time [MD=–13.39, 95%CI (–20.16, –6.62), P<0.001], shorter length of hospital stay [MD=–0.81, 95%CI (–1.46, –0.26), P=0.005], shorter chest tube duration [MD=–0.73, 95%CI (–1.36, –0.10), P=0.02], shorter postoperative anesthesia recovery time [MD=–20.34, 95%CI (–26.83, –13.84), P<0.001], and shorter time to oral intake after surgery [MD=–5.68, 95%CI (–7.63, –3.73), P<0.001]. Furthermore, NIVATS showed a lower incidence of postoperative airway complications [OR=0.49, 95%CI (0.34, 0.71), P<0.001] and less total chest tube drainage volume [MD=–251.11, 95%CI (–398.25, –103.98), P<0.001], all contributing to significantly accelerated postoperative enhanced recovery for patients.Conclusion NIVATS is a safe and technically feasible anesthesia method in thoracoscopic lobectomy, which can to some extent replace IVATS.

1.	Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
2.	Hoy H, Lynch T, Beck M. Surgical treatment of lung cancer. Crit Care Nurs Clin North Am, 2019, 31(3): 303-313.
3.	Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
4.	Metelmann I, Broschewitz J, Pietsch UC, et al. Procedural times in early non-intubated VATS program: a propensity score analysis. BMC Anesthesiol, 2021, 21(1): 44.
5.	Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: The future of thoracic surgery? Eur J Cardiothorac Surg, 2016, 49(3): 721-731.
6.	Anile M, Vannucci J, Ferrante F, et al. Non-intubated thoracic surgery: Standpoints and perspectives. Front Surg, 2022, 9: 937633.
7.	Rodriguez-Canales J, Parra-Cuentas E, Wistuba II. Diagnosis and molecular classification of lung cancer. Cancer Treat Res, 2016, 170: 25-46.
8.	赵帅. 保留自主呼吸喉罩全麻和双腔气管插管全麻在胸腔镜肺叶切除术中的临床对照研究. 河北医科大学, 2021.Zhao S. Clinical comparative study of general anesthesia withlaryngeal mask airway and double lumen endotrachealintubation in thoracoscopic lobectomy. Hebei Medical University, 2021.
9.	方子文, 方万强, 阮玲玲, 等. 自主呼吸麻醉下单操作孔胸腔镜手术治疗非小细胞肺癌临床分析. 中华实用诊断与治疗杂志, 2018, 32(10): 1019-1021.Fang ZW, Fang WQ, Ran LL, et al. Uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer under non-intubated anesthesia with spontaneous respiration. J Chin Pract Diagn Ther, 2018, 32(10): 1019-1021.
10.	张洪江, 潘维敏, 张林等. 喉罩全麻和气管插管全麻在单孔胸腔镜肺叶切除术中的临床对照研究. 实用医学杂志, 2017, 33(3): 455-458.Zhang HJ, Pan WM, Zhang L, et al. Comparison of laryngeal mask anesthesia and intubation anesthesia under spontaneous ventilation in uniportal video-assisted thoracoscopic surgery. J Pract Med, 2017, 33(3): 455-458.
11.	Zheng J, Liang H, Wang R, et al. Perioperative and long-term outcomes of spontaneous ventilation video-assisted thoracoscopic surgery for non-small cell lung cancer. Transl Lung Cancer Res, 2021, 10(10): 3875-3887.
12.	Jeon J, Sung S, Moon Y, et al. Comparison of early postoperative cytokine changes in patients undergoing intubated and non-intubated thoracic surgery: a randomized controlled trial. Interact Cardiovasc Thorac Surg, 2021, 32(3): 343-350.
13.	Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov, 2015, 22(2): 123-130.
14.	Liu J, Cui F, Pompeo E, et al. The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer: a propensity score matching analysis. Eur J Cardiothorac Surg, 2016, 50(5): 920-925.
15.	Pathonsamit C, Tantraworasin A, Poopipatpab S, et al. Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis. BMC Anesthesiol, 2022, 22(1): 154.
16.	Wang ML, How CH, Hung MH, et al. Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage Ⅰ non-small cell lung cancer: a propensity-matched analysis. J Formos Med Assoc, 2021, 120(11): 1949-1956.
17.	Huang C, Huang Q, Shen Y, et al. General anaesthesia with double-lumen intubation compared to opioid-sparing strategies with laryngeal mask for thoracoscopic surgery: a randomised trial. Anaesth Crit Care Pain Med, 2022, 41(3): 101083.
18.	Wu CY, Chen JS, Lin YS, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg, 2013, 95(2): 405-411.
19.	AlGhamdi ZM, Lynhiavu L, Moon YK, et al. Comparison of non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer. J Thorac Dis, 2018, 10(7): 4236-4243.
20.	Cai LS, Hou B, Jin H, et al. Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia. Ann Transl Med, 2021, 9(24): 1783.
21.	Lan L, Cen Y, Zhang C, et al. A propensity score-matched analysis for non-intubated thoracic surgery. Med Sci Monit, 2018, 24: 8081-8087.
22.	Wang B, Ge S. Nonintubated anesthesia for thoracic surgery. J Thorac Dis, 2014, 6(12): 1868-1874.
23.	Andrews WG, Paul S. Techniques of video-assisted thoracoscopic surgery lobectomy and critical review of published data. Future Oncol, 2016, 12(23s): 31-33.
24.	Hernandez-Vaquero D, Vigil-Escalera C, Pérez-Méndez I, et al. Survival after thoracoscopic surgery or open lobectomy: systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(1): 302-313.
25.	Yu Y, Liu RS, Bo Y, et al. Comparison of two preoperative positioning techniques and unpositioning methods in non-intubated video-assisted thoracoscopic surgery. J Thorac Dis, 2022, 14(2): 464-473.
26.	Ambrogi V, Patirelis A, Tajè R. Non-intubated thoracic surgery: wedge resections for peripheral pulmonary nodules. Front Surg, 2022, 9: 853643.
27.	Wang R, Jiang Y, He J, et al. Electromagnetic navigation bronchoscopy integrated non-intubated uniportal VATS in localization and resection of pulmonary nodules. Front Surg, 2022, 9: 872496.
28.	Yang JT, Hung MH, Chen JS, et al. Anesthetic consideration for nonintubated VATS. J Thorac Dis, 2014, 6(1): 10-13.
29.	Kaseda S, Aoki T, Hangai N, et al. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg, 2000, 70(5): 1644-1646.

1. Bade BC, Dela Cruz CS. Lung cancer 2020: epidemiology, etiology, and prevention. Clin Chest Med, 2020, 41(1): 1-24.
2. Hoy H, Lynch T, Beck M. Surgical treatment of lung cancer. Crit Care Nurs Clin North Am, 2019, 31(3): 303-313.
3. Bendixen M, Jørgensen OD, Kronborg C, et al. Postoperative pain and quality of life after lobectomy via video-assisted thoracoscopic surgery or anterolateral thoracotomy for early stage lung cancer: a randomised controlled trial. Lancet Oncol, 2016, 17(6): 836-844.
4. Metelmann I, Broschewitz J, Pietsch UC, et al. Procedural times in early non-intubated VATS program: a propensity score analysis. BMC Anesthesiol, 2021, 21(1): 44.
5. Gonzalez-Rivas D, Bonome C, Fieira E, et al. Non-intubated video-assisted thoracoscopic lung resections: The future of thoracic surgery? Eur J Cardiothorac Surg, 2016, 49(3): 721-731.
6. Anile M, Vannucci J, Ferrante F, et al. Non-intubated thoracic surgery: Standpoints and perspectives. Front Surg, 2022, 9: 937633.
7. Rodriguez-Canales J, Parra-Cuentas E, Wistuba II. Diagnosis and molecular classification of lung cancer. Cancer Treat Res, 2016, 170: 25-46.
8. 赵帅. 保留自主呼吸喉罩全麻和双腔气管插管全麻在胸腔镜肺叶切除术中的临床对照研究. 河北医科大学, 2021.Zhao S. Clinical comparative study of general anesthesia withlaryngeal mask airway and double lumen endotrachealintubation in thoracoscopic lobectomy. Hebei Medical University, 2021.
9. 方子文, 方万强, 阮玲玲, 等. 自主呼吸麻醉下单操作孔胸腔镜手术治疗非小细胞肺癌临床分析. 中华实用诊断与治疗杂志, 2018, 32(10): 1019-1021.Fang ZW, Fang WQ, Ran LL, et al. Uniportal video-assisted thoracoscopic surgery for non-small cell lung cancer under non-intubated anesthesia with spontaneous respiration. J Chin Pract Diagn Ther, 2018, 32(10): 1019-1021.
10. 张洪江, 潘维敏, 张林等. 喉罩全麻和气管插管全麻在单孔胸腔镜肺叶切除术中的临床对照研究. 实用医学杂志, 2017, 33(3): 455-458.Zhang HJ, Pan WM, Zhang L, et al. Comparison of laryngeal mask anesthesia and intubation anesthesia under spontaneous ventilation in uniportal video-assisted thoracoscopic surgery. J Pract Med, 2017, 33(3): 455-458.
11. Zheng J, Liang H, Wang R, et al. Perioperative and long-term outcomes of spontaneous ventilation video-assisted thoracoscopic surgery for non-small cell lung cancer. Transl Lung Cancer Res, 2021, 10(10): 3875-3887.
12. Jeon J, Sung S, Moon Y, et al. Comparison of early postoperative cytokine changes in patients undergoing intubated and non-intubated thoracic surgery: a randomized controlled trial. Interact Cardiovasc Thorac Surg, 2021, 32(3): 343-350.
13. Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery under epidural anesthesia compared with conventional anesthetic option: a randomized control study. Surg Innov, 2015, 22(2): 123-130.
14. Liu J, Cui F, Pompeo E, et al. The impact of non-intubated versus intubated anaesthesia on early outcomes of video-assisted thoracoscopic anatomical resection in non-small-cell lung cancer: a propensity score matching analysis. Eur J Cardiothorac Surg, 2016, 50(5): 920-925.
15. Pathonsamit C, Tantraworasin A, Poopipatpab S, et al. Perioperative outcomes of non-intubated versus intubated video-assisted thoracoscopic surgery in different thoracic procedures: a propensity score-matched analysis. BMC Anesthesiol, 2022, 22(1): 154.
16. Wang ML, How CH, Hung MH, et al. Long-term outcomes after nonintubated versus intubated thoracoscopic lobectomy for clinical stage Ⅰ non-small cell lung cancer: a propensity-matched analysis. J Formos Med Assoc, 2021, 120(11): 1949-1956.
17. Huang C, Huang Q, Shen Y, et al. General anaesthesia with double-lumen intubation compared to opioid-sparing strategies with laryngeal mask for thoracoscopic surgery: a randomised trial. Anaesth Crit Care Pain Med, 2022, 41(3): 101083.
18. Wu CY, Chen JS, Lin YS, et al. Feasibility and safety of nonintubated thoracoscopic lobectomy for geriatric lung cancer patients. Ann Thorac Surg, 2013, 95(2): 405-411.
19. AlGhamdi ZM, Lynhiavu L, Moon YK, et al. Comparison of non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer. J Thorac Dis, 2018, 10(7): 4236-4243.
20. Cai LS, Hou B, Jin H, et al. Clinical evaluation of the rapid recovery of patients who underwent video-assisted thoracoscopic lung surgery under non-intubated anesthesia. Ann Transl Med, 2021, 9(24): 1783.
21. Lan L, Cen Y, Zhang C, et al. A propensity score-matched analysis for non-intubated thoracic surgery. Med Sci Monit, 2018, 24: 8081-8087.
22. Wang B, Ge S. Nonintubated anesthesia for thoracic surgery. J Thorac Dis, 2014, 6(12): 1868-1874.
23. Andrews WG, Paul S. Techniques of video-assisted thoracoscopic surgery lobectomy and critical review of published data. Future Oncol, 2016, 12(23s): 31-33.
24. Hernandez-Vaquero D, Vigil-Escalera C, Pérez-Méndez I, et al. Survival after thoracoscopic surgery or open lobectomy: systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(1): 302-313.
25. Yu Y, Liu RS, Bo Y, et al. Comparison of two preoperative positioning techniques and unpositioning methods in non-intubated video-assisted thoracoscopic surgery. J Thorac Dis, 2022, 14(2): 464-473.
26. Ambrogi V, Patirelis A, Tajè R. Non-intubated thoracic surgery: wedge resections for peripheral pulmonary nodules. Front Surg, 2022, 9: 853643.
27. Wang R, Jiang Y, He J, et al. Electromagnetic navigation bronchoscopy integrated non-intubated uniportal VATS in localization and resection of pulmonary nodules. Front Surg, 2022, 9: 872496.
28. Yang JT, Hung MH, Chen JS, et al. Anesthetic consideration for nonintubated VATS. J Thorac Dis, 2014, 6(1): 10-13.
29. Kaseda S, Aoki T, Hangai N, et al. Better pulmonary function and prognosis with video-assisted thoracic surgery than with thoracotomy. Ann Thorac Surg, 2000, 70(5): 1644-1646.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesShort-term efficacy of non-intubation anesthesia in thoracoscopic lobectomy for lung cancer: a systematic review and meta-analysis

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