Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy.

BACKGROUND: We hypothesized that video-assisted thoracic surgery (VATS) lung metastasectomy under non-intubated anesthesia may have a lesser immunological and inflammatory impact than the same procedure under general anesthesia.

METHODS: Between December 2005 and October 2015, 55 patients with pulmonary oligometastases (at the first episode) successfully underwent VATS metastasectomy under non-intubated anesthesia. Lymphocytes subpopulation and interleukins 6 and 10 were measured at different intervals and matched with a control group composed of 13 patients with similar clinical features who refused non-intubated surgery.

RESULTS: The non-intubated group demonstrated a lesser reduction of natural killer lymphocytes at 7 days from the procedure ( p = 0.04) compared to control. Furthermore, the group revealed a lesser spillage of interleukin 6 after 1 ( p = 0.03), 7 ( p = 0.04), and 14 ( p = 0.05) days. There was no mortality in any groups. Major morbidity rate was significantly higher in the general anesthesia group 3 (5%) vs. 3 (23%) ( p = 0.04). The median hospital stay was 3.0 vs. 3.7 ( p = 0.033) days, the estimated costs with the non-intubated procedure was significantly lower, even excluding the hospital stay.

CONCLUSIONS: VATS lung metastasectomy in non-intubated anesthesia had significantly lesser impact on both immunological and inflammatory response compared to traditional procedure in intubated general anesthesia.