Nonintubated anesthesia lowers postoperative NLR in thoracoscopic lung cancer resection compared to traditional intubation.
Photo by Günter Valda / Unsplash
Key Takeaway
Consider nonintubated anesthesia for thoracoscopic lung resection; preliminary data suggests lower postoperative NLR.
This randomized controlled trial evaluated the effects of nonintubated video-assisted thoracic surgery (NIVATS) versus traditional video-assisted thoracic surgery (VATS) on inflammatory and tumor markers in patients undergoing lung cancer resection. The study included 58 patients (29 per group) at a tertiary medical institution, with outcomes assessed 24 hours postoperatively.
The primary outcome measured the neutrophil-to-lymphocyte ratio (NLR) in peripheral blood. Results indicated that the NLR was significantly lower in the NIVATS group compared to the VATS group (p = 0.031). Additionally, neutrophil percentage was significantly lower in the NIVATS group (p = 0.006), while lymphocyte percentage was significantly higher in the NIVATS group (p = 0.013).
No significant differences were observed between the two groups regarding peripheral blood tumor markers. Safety outcomes included chest air leaks, pneumonia, acute respiratory distress syndrome incidence, new-onset atrial fibrillation, hoarseness, sore throat, and dysphonia. The study did not report specific adverse event rates, serious adverse events, discontinuations, or tolerability data.
Key limitations include the small sample size and the lack of reported funding or conflict of interest information. The study was conducted at a single tertiary institution, which may limit generalizability. While the results suggest a potential reduction in systemic inflammation with nonintubated anesthesia, the evidence is derived from a single trial with incomplete safety reporting.
Clinicians should interpret these findings as preliminary evidence that nonintubated anesthesia may reduce postoperative inflammatory markers in selected lung cancer patients. Further research with larger cohorts and comprehensive safety data is necessary to determine the routine applicability of this technique.
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View Original Abstract ↓
OBJECTIVES: To assess the influence of nonintubated anesthesia on the neutrophil-to-lymphocyte ratio (NLR) and tumor marker level in patients undergoing thoracoscopic resection of lung cancer.
DESIGN: A prospective, randomized, controlled trial.
SETTING: A tertiary medical institution.
PARTICIPANTS: Fifty-eight patients underwent video-assisted thoracoscopic lung surgery.
INTERVENTION: Patients were randomly divided into the nonintubated video-assisted thoracic surgery group (NIVATS group, n = 29) and the traditional video-assisted thoracic surgery group (VATS group, n = 29) in a 1:1 allocation ratio.
MEASUREMENTS AND MAIN RESULTS: The primary outcome was the NLR in peripheral blood, measured 24 hours postoperatively. Secondary outcomes included a range of peripheral blood tumor markers (derived neutrophil to lymphocyte ratio/lactate dehydrogenase (dNLR/LDH), citrullinated histone H3, matrix metalloproteinase 9, programmed death ligand 1, systemic inflammatory immune index, vascular endothelial growth factor) at the same time point, as well as intraoperative minimum blood oxygen saturation, thoracotomy conversion rate, blood loss, recovery metrics (chest tube duration, discharge time), and postoperative complications (chest air leaks, pneumonia, acute respiratory distress syndrome incidence, new-onset atrial fibrillation, hoarseness, sore throat, dysphonia). Notably, 24 hours after surgery, the NLR and neutrophil percentage were significantly lower in the NIVATS group compared to the VATS group (p = 0.031, p = 0.006), accompanied by a higher lymphocyte percentage (p = 0.013). However, enzyme-linked immunosorbent assay results for peripheral blood tumor markers showed no significant differences between the 2 groups, both before and 24 hours after surgery.
CONCLUSIONS: Compared to the VATS group, the use of nonintubated anesthesia resulted in less postoperative NLR elevation but had no significant impact on the levels of tumor biomarkers.
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