Ambrogi Vincenzo, Sellitri Francesco, Perroni Gianluca, Schillaci Orazio, Mineo Tommaso Claudio
Thoracic Surgery, Tor Vergata University, Rome Italy.
Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Tor Vergata University Rome, Rome, Italy.
J Thorac Dis. 2017 Feb;9(2):254-261. doi: 10.21037/jtd.2017.02.40.
More than ten years ago we started a program of video-assisted thoracic surgery (VATS) lung metastasectomy in non-intubated local anesthesia. In this study we investigated the effectiveness and long term results of this combined surgical-anesthesiological technique.
Between 2005 and 2014, 48 patients (25 men and 23 women) with pulmonary oligometastases from colorectal cancer, at the first episode, underwent VATS metastasectomy under non-intubated local anesthesia. Three patients required intubation for intolerance. In the same period 13 patients scheduled for non-intubated metastasectomy refused awake surgery and were used as a control group.
The two groups were homogeneous for both demographic and pathological features. Mean number of lesions resected per patient were 1.51 (non-intubated) 1.77 (control), respectively (P=0.1). The oxygenation was significantly lower in the non-intubated group especially at the end of the procedure, but the values inverted from the first postoperative hour. There was no mortality in any groups. The non-intubated group demonstrated a significant shorter overall operating time (P=0.04), better quality of recovery after both 24 (P=0.04) and 48 hours (P=0.04), shorter median hospital stay (P=0.03) and lower estimated costs (P=0.03), even excluding the hospital stay. Major morbidity rate was lower (6% 23%) yet not significant (P=0.1). Both disease free survival and overall survival were similar between groups.
VATS lung metastasectomy in non-intubated local anesthesia was safely performed in selected patients with oligometastases with significant advantages in overall operative time, hospital stay and economical costs. Morbidity rate was lower yet not significant. Long term results were similar.
十多年前，我们启动了一项在非插管局部麻醉下进行电视辅助胸腔镜手术（VATS）肺转移瘤切除术的项目。在本研究中，我们调查了这种联合手术 - 麻醉技术的有效性和长期结果。
2005年至2014年间，48例（25例男性和23例女性）首次发生的来自结直肠癌的肺寡转移患者在非插管局部麻醉下接受了VATS转移瘤切除术。3例患者因不耐受需要插管。同期，13例计划进行非插管转移瘤切除术的患者拒绝清醒手术，并被用作对照组。
两组在人口统计学和病理特征方面均具有同质性。每位患者切除的平均病灶数分别为1.51（非插管组）和1.77（对照组）（P = 0.1）。非插管组的氧合水平明显较低，尤其是在手术结束时，但从术后第一小时起数值发生反转。两组均无死亡病例。非插管组的总手术时间明显更短（P = 0.04），术后24小时（P = 0.04）和48小时（P = 0.04）的恢复质量更好，中位住院时间更短（P = 0.03），估计费用更低（P = 0.03），即使不包括住院时间。主要发病率较低（6%对23%），但差异不显著（P = 0.1）。两组之间的无病生存期和总生存期相似。
在选定的寡转移患者中，非插管局部麻醉下的VATS肺转移瘤切除术安全可行，在总手术时间、住院时间和经济成本方面具有显著优势。发病率较低，但差异不显著。长期结果相似。
