The Effects of Nonintubated Anesthesia onNeutrophil-to-Lymphocyte Ratio and Tumor Markers Among Patients Undergoing Thoracoscopic Lung Resection: A Randomized Controlled Trial.

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.