Chen Pei-Hsing, Chuang Jen-Hao, Lu Tzu-Pin, Hung Wan-Ting, Liao Hsien-Chi, Tsai Tung-Ming, Lin Mong-Wei, Chen Ke-Cheng, Hsu Hsao-Hsun, Chen Jin-Shing
Division of Thoracic Surgery, Department of Surgery, National Taiwan University Hospital Yun-Lin Branch, Yunlin County, Taiwan.
Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
Front Surg. 2022 May 2;9:880007. doi: 10.3389/fsurg.2022.880007. eCollection 2022.
In most developed countries, lung cancer is associated with the highest mortality rate among all cancers. The number of elderly patients with lung cancer is increasing, reflecting the global increase in aging population. Patients with impaired lung or cardiac function are at a high risk during intubated general anesthesia, which may preclude them from surgical lung cancer treatment. We evaluated the safety and survival of non-intubated video-assisted thoracoscopic surgery (VATS) versus those of intubated thoracoscopic surgery for surgical resection for lung cancer in older patients.
Patients aged ≥75 years who underwent non-intubated and intubated VATS resection with pathologically confirmed non-small cell lung cancer, using a combination of thoracic epidural anesthesia or intercostal nerve block and intra-thoracic vagal block with target-controlled sedation, from January 2011 to December 2019 were included. Ultimately, 79 non-intubated patients were matched to 158 patients based on age, sex, body mass index, family history, comorbidity index, pulmonary function (forced expiratory volume in one second/ forced vital capacity [%]), and disease stage. The endpoints were overall survival and recurrence progression survival.
All patients had malignant lung lesions. Data regarding conversion data and the postoperative result were collected. Both groups had comparable preoperative demographic and cancer staging profiles. The anesthetic duration in the non-intubated group was shorter than that in the intubated group, which showed a significantly higher mean number of lymph nodes harvested (intubated vs non-intubated, 8.3 vs. 6.4) and lymph stations dissected (3.0 vs. 2.6). Intensive care unit (ICU) admission rate and postoperative ICU stay were significantly longer in the intubated group. The complication rate was higher and hospital stay were longer in the intubated group, but these differences were not significant (12% vs. 7.6%; = .07, respectively).
In the elderly, non-intubated thoracoscopic surgery provides similar survival results as the intubated approach, although fewer lymph nodes are harvested. Non-intubated surgery may serve as an alternative to intubated general anesthesia in managing lung cancer in carefully selected elderly patients with a high risk of impaired pulmonary and cardiac function.
在大多数发达国家，肺癌在所有癌症中死亡率最高。老年肺癌患者数量不断增加，这反映了全球老龄化人口的增长。肺或心功能受损的患者在气管插管全身麻醉期间风险较高，这可能使他们无法接受肺癌手术治疗。我们评估了非气管插管电视辅助胸腔镜手术（VATS）与气管插管胸腔镜手术对老年患者肺癌手术切除的安全性和生存率。
纳入2011年1月至2019年12月期间年龄≥75岁、接受非气管插管和气管插管VATS切除且病理确诊为非小细胞肺癌的患者，采用胸段硬膜外麻醉或肋间神经阻滞联合胸腔内迷走神经阻滞及靶控镇静。最终，根据年龄、性别、体重指数、家族史、合并症指数、肺功能（一秒用力呼气量/用力肺活量 [%]）和疾病分期，将79例非气管插管患者与158例患者进行匹配。终点指标为总生存期和复发进展生存期。
所有患者均有肺部恶性病变。收集了关于中转数据和术后结果的数据。两组术前人口统计学和癌症分期资料具有可比性。非气管插管组的麻醉持续时间短于气管插管组，气管插管组平均获取的淋巴结数量（气管插管组 vs 非气管插管组，8.3 vs. 6.4）和清扫的淋巴结站数（3.0 vs. 2.6）显著更多。气管插管组重症监护病房（ICU）入住率和术后ICU住院时间显著更长。气管插管组的并发症发生率更高，住院时间更长，但这些差异不显著（分别为12% vs. 7.6%；P = 0.07）。
在老年患者中，非气管插管胸腔镜手术与气管插管手术的生存结果相似，尽管获取的淋巴结较少。对于精心挑选的肺和心功能受损风险高的老年患者，非气管插管手术可作为气管插管全身麻醉管理肺癌的替代方法。
