Non-intubated versus intubated video-assisted thoracoscopic lobectomy for lung cancer patients

Video-assisted thoracoscopic surgery (VATS) lobectomy has been shown to be a standard treatment for lung cancer patient due to less pain, post-operative complication and faster recovery. In recent years, Non-intubated video-assisted thoracoscopic surgery (NIVATS) is become an alternative approach for various types of thoracic surgery with a benefit on fewer complication from mechanical ventilation. Out study is aimed to study outcome compare between NIVATS lobectomy and to general anesthetic video assisted thoracoscopic surgery (GAVATS) lobectomy.

This is a retrospective cohort study conduct in Vajira hospital, Navamindradhiraj University, Bangkok, Thailand between January 2019 to September 2022.152 lung cancer patients underwent lobectomy. However, lung cancer patients whom needed to convert to GAVATS, open thoracotomy or emergency surgery were excluded from this study. In this study, we compare lung patients whom underwent NIVATS lobectomy and those whom underwent GAVATS lobectomy. These two groups are compared in term of pre-, intra- and post-operative outcomes. The inverse-probability weighting propensity score is used to identify the treatment effects of NIVATS.

In total, there are 132 cases patients including in this analysis. There are 54 and 78 patients in the NIVATS and GAVATS respectively. Intra-operative outcome, induction and operative time are lower in the NIVATS lobectomy group (25 vs 30 min, p < 0.001 and 90 vs 120 min, p = 0.003). There is no difference regarding number of node resection, station of lymph node dissection, arrhythmia, postoperative complications, and pain visual analogue score (VAS) in both groups. Postoperative outcome, length of hospital stay is shorter in NIVATS lobectomy group (4 vs 5 days, p < 0.001). There is no patient which needed to convert from NIVATS to GAVATS. The treatment-effect analyzed by using inverse-probability weighting propensity score has shown benefits of NIVATS in terms of shorter hospital stays (coefficient -2.31, 95%CI -3.65 to -0.97, p = 0.001), and shorter chest tube duration (coefficient -1.59, 95%CI -2.93 to -0.26, p = 0.019).

NIVATS lobectomy could be an alternative approach for lung cancer patients with benefits of lesser in hospital stays and duration of chest tube.