The safety and feasibility of non-intubated versus intubated video-assisted thoracic surgery in NSCLC patients after neoadjuvant therapy: a propensity score matching study.

BACKGROUND

Lung cancer is the leading cause of cancer-related death worldwide, with non-small cell lung cancer (NSCLC) accounting for over 85% of cases. Surgical resection is the main treatment for early-stage NSCLC, and neoadjuvant therapy is widely used for locally advanced or high-risk patients to improve resectability and survival. Video-assisted thoracoscopic surgery (VATS) has become the standard minimally invasive approach. With the development of enhanced recovery after surgery protocols, non-intubated VATS (NI-VATS) has shown advantages in reducing airway injury, postoperative complications, and accelerating recovery. However, the safety of NI-VATS in patients receiving neoadjuvant therapy remains unclear. Neoadjuvant therapy may cause tissue fibrosis and adhesions, and the unstable surgical field of NI-VATS increases surgical concerns. Relevant evidence is still limited. This study aims to explore the safety and feasibility of NI-VATS in NSCLC patients after neoadjuvant therapy, and to compare the safety and feasibility of NI-VATS versus intubated video-assisted thoracic surgery (I-VATS) in patients with NSCLC after neoadjuvant therapy.

METHODS

The clinical data of 181 NSCLC patients who underwent surgical treatment after neoadjuvant therapy in the Affiliated Hospital of Hebei University from June 2022 to December 2024 were retrospectively analyzed. Patients were divided into the NI-VATS group (n=36) and the I-VATS group (n=145) by anesthesia method. After 1:1 propensity score matching (PSM), 31 pairs of balanced baseline data were selected to compare the perioperative outcomes.

RESULTS

After PSM, the baselines of the two groups of patients were balanced. Operative time, intraoperative blood loss, lymph node (group and number), R0 resection rates, and postoperative drainage volumes were similar between groups (P>0.05). The NI-VATS group demonstrated significantly shorter anesthesia auxiliary airway removal time (12.32±10.46 vs. 19.45±6.81 min, P=0.003), shorter postoperative fasting time (6.39±6.61 vs. 10.48±6.53 h, P=0.02), reduced postoperative inflammatory response (lower 24 h white blood cell (WBC) and ΔWBC, P<0.05), lower incidence of postoperative complications (delirium, cough, sore throat/hoarseness, respiratory infection; P<0.05), shorter postoperative hospital stay (6.58±2.43 vs. 9.22±4.87 days, P=0.009), and lower hospitalization costs (47,324.90±6,976.54 vs. 51,477.78±4,939.09 ¥, P=0.009).

CONCLUSIONS

For NSCLC patients after neoadjuvant therapy, NI-VATS is a safe, feasible and effective surgical method. It significantly enhances postoperative recovery, reducing complications and resource utilization, aligning well with enhanced recovery after surgery (ERAS) principles. It is worthy of further necessary research and promotion.