Non-intubated spontaneous ventilation offers better short term outcome for mediastinal tumor surgery.

Abstract

BACKGROUND\nNon-intubated spontaneous-ventilation video-assisted thoracoscopic surgery (NI-VATS) has been investigated to reduce the adverse effects of tracheal intubation, mechanical ventilation and general anesthesia in several thoracic diseases. We comparatively assess the comparison between NI-VATS versus intubated-anaesthesia VATS (I-VATS) on early outcomes of mediastinal lesion resection.\n\n\nMETHODS\nPatients that underwent VATS resection for a mediastinal tumor between December 2015 and September 2018 were retrospectively included for analysis. Patients were divided into two groups according to anesthesia ventilation type: NI-VATS and I-VATS. Propensity score matching was applied to eliminate population bias. Intraoperative and postoperative variables were compared.\n\n\nRESULTS\nA total of 198 patients were included, of which 75 patients underwent NI-VATS and 123 patients underwent I-VATS. After PSM. Both anesthesia time (173.81 vs 227.37 min; p<0.001) and operation time (82.82 vs 133.49 min; p<0.001) were shorter in NI-VATS group. Bleeding (51.80 vs 56.73 ml; p=0.90) and post-operative morbidity (10.9% vs 15.6%; p=0.57) were similar between groups. Chest tube duration (1.11 vs 1.54 day; p=0.04) was shorter in the NI-VATS group. Hospital duration after surgery (3.15 vs 5.35 days; p<0.001) were shorter in the NI-VATS group. D-dimer after surgery was significantly higher in both groups, but NI-VATS decrease the change (577 vs 1624μg/L; p<0.001). Furthermore, a decrease in the use of postoperative opioids analgesics was seen in the NI-VATS group (31% vs 51%, P=0.023).\n\n\nCONCLUSIONS\nMediastinal tumor resection is safe and feasible under NI-VATS. Better short term outcomes suggest NI-VATS facilitates a more rapid recovery. Further multi-center prospective randomized investigation is warranted.