Spontaneous Ventilation Video-Assisted Thoracoscopic Surgery for Geriatric Patients With Non-Small-Cell Lung Cancer.

Abstract

OBJECTIVES\nThe aim of the present study was to compare the short-term outcomes between spontaneous ventilation video-assisted thoracic surgery (SV-VATS) and mechanical ventilation video-assisted thoracic surgery (MV-VATS) in the elderly. All patients included in the present study underwent lobectomy, segmentectomy, or wedge resection and lymph node dissection.\n\n\nDESIGN\nA retrospective cohor.\n\n\nSETTING\nThe first affiliated hospital of Guangzhou Medical University, Guangzhou, China.\n\n\nPARTICIPANTS\nThe present study included 799 elderly patients diagnosed with non-small-cell lung cancer undergoing SV-VATS or MV-VATS. After propensity score matching, 80 patients in the SV-VATS group and 80 patients in the MV-VATS group were analyzed.\n\n\nINTERVENTIONS\nPatients in the SV-VATS group received spontaneous-ventilation anesthesia, which was administered as follows: intravenous anesthesia\xa0+\xa0laryngeal mask airway\xa0+\xa0thoracic paravertebral block\xa0+\xa0visceral pleural surface anesthesia\xa0+\xa0thoracic vagus nerve block. Patients in the MV-VATS group received general endotracheal anesthesia. SV-VATS or MV-VATS was performed according to the preference of the patients.\n\n\nMEASUREMENTS AND MAIN RESULTS\nThere were no significant differences in anesthesia time (226.3 ± 79.8 v 238.5 ± 66.2 min; p\xa0=\xa00.44), surgery time (166.2 ± 102.6 v 170.1 ± 83.4 min; p\xa0=\xa00.66), and number of dissected lymph nodes (5.3 ± 7.5 v 4.4 ± 7.4; p\xa0=\xa00.23) between the two groups. There were significant differences in intraoperative bleeding (61.5 ± 165.1 v 82.2 ± 116.9 mL; p < 0.001). After surgery, the two groups were statistically comparable in terms of hospitalization (17.6 ± 7.6 v 17.2 ± 6.9 days; p\xa0=\xa00.95) and incidence of complications (7.5% v 13.8%; p\xa0=\xa00.20), while there were significant differences in chest tube duration (6.1 ± 3.3 v 4.5 ± 1.2 days; p < 0.001).\n\n\nCONCLUSIONS\nSV-VATS is feasible and as safe as MV-VATS, and it could be considered as an alternative treatment for the elderly.