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Review
. 2025 Jan 13;20(1):62.
doi: 10.1186/s13019-024-03313-6.

Awake thoracic surgery for lung cancer treatment: where we are and future perspectives-our experience and review of literature

Giovanni Mugnaini  1 , Simone Tombelli  1 , Antonio Burlone  1 , Stefano Bongiolatti  1 , Domenico Viggiano  1 , Rossella Indino  1 , Ottavia Salimbene  1 , Lavinia Gatteschi  1 , Luca Voltolini  1   2 , Alessandro Gonfiotti  3   4
Affiliations
Review

Awake thoracic surgery for lung cancer treatment: where we are and future perspectives-our experience and review of literature

Giovanni Mugnaini et al. J Cardiothorac Surg. .

Abstract

Background: Lung cancer is the first cause of cancer-related death. Awake lung resection is a new frontier of the concept of minimally invasive surgery. Our purpose is to demonstrate the feasibility of this technique for lobar and sublobar lung resection in NSCLC patients.

Methods: We retrospective reviewed all the medical charts of patients who underwent awake lung resection in our center between March 2018 and March 2024, focusing on patients with NSCLC, and we compared our results with the ones found in literature.

Results: Among 45 patients treated with awake lung resections, we selected 15 patients with NSCLC and finally analyzed the results of 12 patients who underwent VATS awake lung resection, 3 lobectomies and 9 wedge resections. The median Charlson comorbidity index (CCI) was 3 and we had 5 patients (41.67%) with a CCI ≥ 4 and a median FEV1 of 56%. We report only 2 conversions to general anesthesia (16.67%) and no conversion to open thoracotomy. We used a nebulizator for the atomization of lidocaine on the lung surface to reduce the cough reflex. Our post-operative results are in line with literature, with a low complication rate (2 patients, 16.67%) and a median length of stay of 5 days. We safely performed a proper lymph node dissection in all 3 lobectomies. Median Overall Survival and Disease-Free Survival were 11 months.

Conclusions: Awake lung resections are a feasible way to perform a minimally invasive surgical procedure in NSCLC patients, with low risk of conversion to open surgery.

Keywords: Awake lung resections; Minimally invasive lung surgery; NSCLC surgery, uniportal VATS surgery; Spontaneous breathing patients; VATS lung resections.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board. Ethical review and approval were waived for this study due to the retrospective nature of the article. Informed consent was obtained from each patient. Consent for publication: The retrospective analysis of the data did not require a specific protocol. Our Institutional Review Board granted approval and waived the requirement for specific informed consent for this retrospective analysis. Surgical informed consent was obtained from all subjects involved in the study. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Lidocaine atomization on the lung surface and into the fissure to inhibit the cough reflex
See this image and copyright information in PMC

References

    1. GLOBOCAN. Available Online: https://gco.iarc.who.int/today/en/dataviz/bars?mode=cancer&key=total&gro.... Accessed 21 Jun 2024
    1. Lim E, Batchelor TJP, Dunning J, Shackcloth M, Anikin V, Naidu B, Belcher E, Loubani M, Zamvar V, Harris RA, Dabner L, McKeon HE, Paramasivan S, Realpe A, Elliott D, De Sousa P, Stokes EA, Wordsworth S, Blazeby JM, Rogers CA. Video-assisted thoracoscopic or open lobectomy in early-stage lung cancer. NEJM Evid. 2022;1(3):EVIDoa2100016. 10.1056/EVIDoa2100016. - DOI - PubMed
    1. Gonzalez-Rivas D, Bonome C, Fieira E, Aymerich H, Fernandez R, Delgado M, Mendez L, de la Torre M. Non-intubated video-assisted thoracoscopic lung resections: the future of thoracic surgery? Eur J Cardiothorac Surg. 2016;49(3):721–31. 10.1093/ejcts/ezv136. - DOI - PubMed
    1. Mugnaini G, Viggiano D, Fontanari P, Forzini R, Voltolini L, Gonfiotti A. Awake uniportal VATS sublobar lung resections in high-comorbidity patients: Single-center early post-operative outcomes. Front Surg. 2023;17(10):1120414. 10.3389/fsurg.2023.1120414. - DOI - PMC - PubMed
    1. Nezu K, Kushibe K, Tojo T, Takahama M, Kitamura S. Thoracoscopic wedge resection of blebs under local anesthesia with sedation for treatment of a spontaneous pneumothorax. Chest. 1997;111(1):230–5. 10.1378/chest.111.1.230. - DOI - PubMed

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