Non-intubated video-assisted thoracic surgery for operable lung cancer: a randomized controlled trial

The safety profile and effect on inflammation of non-intubated video-assisted thoracoscopic surgery (NIVATS) remain incompletely understood. This study aimed to evaluate the safety of NIVATS and its effect on the inflammatory state.

This single-center, randomized, parallel-controlled, double-blind trial enrolled patients with early-stage lung cancer scheduled for video-assisted thoracoscopic surgery in a Chinese tertiary center between September 2020 and October 2021. Patients were randomly assigned in a 1:1 ratio to undergo either NIVATS or intubated video-assisted thoracoscopic surgery (IVATS). Expression levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in blood samples, as well as expression levels of aquaporin-5 (AQP-5), surfactant protein A (SP-A), and high-mobility group box 1 (HMGB-1) in lung tissue samples, were measured. Total white blood cell (WBC) and neutrophil counts were determined using a cell counter.

Intergroup baseline characteristics of 120 included patients (NIVATS group: 60; IVATS group: 60) were comparable. In the NIVATS group, the level of HMGB-1 was decreased (P = 0.03), while the levels of AQP-5 (P < 0.01) and SP-A (P < 0.01) in lung tissue were elevated. Postoperative levels of IL-6 and TNF-α did not differ significantly between the two groups (P > 0.05). Additionally, on postoperative day 1 (WBC: 9.93 ± 0.42 vs. 11.85 ± 0.51 × 109/L, P < 0.01; neutrophil: 74.37 ± 1.13% vs. 83.84 ± 0.94%, P < 0.01) and the day prior to discharge (WBC: 9.93 ± 0.42 vs. 11.85 ± 0.51 × 109/L, P < 0.01; neutrophil: 66.99 ± 1.02% vs. 76.11 ± 1.09%, P< 0.01), the NIVATS group exhibited lower WBC and neutrophil counts compared to the IVATS group.

NIVATS showed superiority over IVATS in maintaining intraoperative hemodynamic stability and reducing the postoperative inflammatory response. NIVATS may represent a safer and more advantageous option for patients with lung malignancies.