Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 15;14(10):3466.
doi: 10.3390/jcm14103466.

Perioperative Outcomes of Non-Intubated Versus Intubated Anesthesia in Video-Assisted Thoracoscopic Surgery for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matched Analysis

Hsiang-Han Huang  1 , Li-Hua Chen  1   2 , Hou-Chuan Lai  1 , Zhi-Fu Wu  1   3   4   5 , Ching-Lung Ko  1   6 , Kai-Li Lo  1   6 , Go-Shine Huang  1 , Wei-Cheng Tseng  1
Affiliations

Perioperative Outcomes of Non-Intubated Versus Intubated Anesthesia in Video-Assisted Thoracoscopic Surgery for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matched Analysis

Hsiang-Han Huang et al. J Clin Med. .

Abstract

Background: Previous studies have shown that ventilation strategies used in general anesthesia influence perioperative outcomes of video-assisted thoracoscopic surgery (VATS). This study investigated the perioperative effects of non-intubated anesthesia (NIA) versus intubated anesthesia (IA) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing VATS. Methods: This retrospective cohort study analyzed patients who underwent elective VATS for early-stage NSCLC between January 2015 and December 2022. Patients were categorized into the NIA and IA groups based on the ventilation strategies during general anesthesia. Comprehensive outcome data, including intraoperative and postoperative variables, were compared between the two groups. Univariate and multivariate logistic regression models were used to assess the odds ratios for conversion from NIA to IA. Results: A total of 372 patients who received NIA and 1560 who received IA for VATS were eligible for analysis. After propensity score matching, 336 patients were included in each group. In the matched analysis, patients who received NIA demonstrated favorable perioperative outcomes, including reduced opioid consumption, lower postoperative complication rates, and shorter hospital stays, compared to those who received IA. Additionally, patients with a lower baseline oxygen saturation and those who experienced intraoperative pulmonary and cardiovascular adverse events had a higher risk of conversion from NIA to IA. Conclusions: NIA during VATS in patients with early-stage NSCLC was associated with superior perioperative outcomes. Prospective studies are warranted to further evaluate the impact of NIA on perioperative outcomes in this patient population.

Keywords: double-lumen tube; intubated anesthesia; laryngeal mask airway; non-intubated anesthesia; non-small cell lung cancer; video-assisted thoracoscopic surgery.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest.

Figures

Figure 1
Figure 1
Flow diagram detailing the selection of patients included in the retrospective analysis. IA, intubated anesthesia; NIA, non-intubated anesthesia; NSCLC, non-small cell lung cancer; VATS, video-assisted thoracoscopic surgery.
Figure 2
Figure 2
Hemodynamic parameters including mean blood pressure, heart rate, and oxygen saturation at selected time points during surgery between the (A) overall and (B) matched groups. IA, intubated anesthesia; NIA, non-intubated anesthesia.
Figure 3
Figure 3
(A) Incidence and (B) causes of unintended conversion from non-intubated anesthesia to intubation anesthesia.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Nasim F., Sabath B.F., Eapen G.A. Lung Cancer. Med. Clin. N. Am. 2019;103:463–473. doi: 10.1016/j.mcna.2018.12.006. - DOI - PubMed
    1. Bade B.C., Dela Cruz C.S. Lung Cancer 2020: Epidemiology, Etiology, and Prevention. Clin. Chest Med. 2020;41:1–24. doi: 10.1016/j.ccm.2019.10.001. - DOI - PubMed
    1. Duma N., Santana-Davila R., Molina J.R. Non-Small Cell Lung Cancer: Epidemiology, Screening, Diagnosis, and Treatment. Mayo Clin. Proc. 2019;94:1623–1640. doi: 10.1016/j.mayocp.2019.01.013. - DOI - PubMed
    1. Whitson B.A., Groth S.S., Duval S.J., Swanson S.J., Maddaus M.A. Surgery for early-stage non-small cell lung cancer: A systematic review of the videoassisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann. Thorac. Surg. 2008;86:2008–2018. doi: 10.1016/j.athoracsur.2008.07.009. - DOI - PubMed
    1. Zhu M., Fu X.N., Chen X. Lobectomy by video-assisted thoracoscopic surgery (VATS) for early stage of non-small cell lung cancer. Front. Med. 2011;5:53–60. doi: 10.1007/s11684-011-0121-2. - DOI - PubMed

LinkOut - more resources