Immunological and Inflammatory Impact of Non-Intubated Lung Metastasectomy

Tommaso Mineo,Vincenzo Ambrogi,Francesco Sellitri,Gianluca Vanni,Filippo Gallina

doi:10.3390/ijms18071466

Abstract

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.

Highlights

The increasing evolution of non-intubated thoracic surgery allowed the execution of progressively more complicated operations in patients with different pathologies [1,2,3,4,5,6]
Operations were done under epidural anesthesia and three-port video-assisted thoracic surgery (VATS) [10] but starting from 2005, lung metastasectomies have been preferably accomplished through a unique thoracoscopic access under non-intubated anesthesia [11]
Major morbidity rate was significantly higher in the intubated group 3 (5%) vs. 3 (23%) (p = 0.04)

Summary

Introduction

The increasing evolution of non-intubated thoracic surgery allowed the execution of progressively more complicated operations in patients with different pathologies [1,2,3,4,5,6]. Operations were done under epidural anesthesia and three-port video-assisted thoracic surgery (VATS) [10] but starting from 2005, lung metastasectomies have been preferably accomplished through a unique thoracoscopic access under non-intubated anesthesia [11]. As a matter of fact, these operations proved capable of generating a lower level of inflammation and lesser degree of immunologic depression than the traditional ones [22,23]. On these bases, we think that the use of non-intubated anesthesia appears suitable in the surgery of oligometastatic patients. We analyzed some pattern of inflammatory and immunological response after lung metastasectomy carried out under non-intubated anesthesia

Immunological Impact

Morbidity

Discussion

Materials and Methods

Conclusions