Awake pulmonary metastasectomy

Area of Science:

• Thoracic Surgery
• Anesthesiology
• Surgical Oncology

Background:

• Pulmonary metastasectomy traditionally requires general anesthesia with single-lung ventilation.
• Bimanual lung palpation is considered essential for complete resection during pulmonary metastasectomy.

Purpose of the Study:

• To evaluate the safety and feasibility of awake pulmonary metastasectomy.
• To assess early oncologic outcomes and patient satisfaction with thoracic epidural anesthesia for this procedure.

Main Methods:

• 14 patients underwent thoracoscopic metastasectomy under sole thoracic epidural anesthesia.
• A modified digital-instrumental palpation method was employed for lung assessment.
• Data were compared to a historical cohort receiving general anesthesia.

Main Results:

• No mortality or major morbidity was observed.
• Technical feasibility was excellent or good in all cases, with high patient satisfaction.
• Awake surgery showed significantly shorter operative times (25.5 vs 48.5 min) and hospital stays (2.5 vs 4.0 days).

Conclusions:

• Awake pulmonary metastasectomy under thoracic epidural anesthesia is a safe and feasible alternative.
• This technique offers reduced resource utilization without compromising oncologic results.
• Comparable recurrence rates and survival suggest equivalence to general anesthesia approaches.