Nonintubated Thoracoscopic Surgery for Lung Tumor: Seven Years’ Experience With 1,025 Patients

Abstract

Nonintubated thoracoscopic surgery for lung tumor is not widely performed. This study assessed the safety, outcome, and risk factors for conversion to tracheal intubation of nonintubated thoracoscopic surgery for lung tumor resection. We retrospectively reviewed the records of 1,025 patients who underwent lung tumor resection by nonintubated thoracoscopic surgery from August 2009 to December 2016 at our institution. Using univariable and multivariable analyses, we focused on the operative procedures, complications, conversion rate, surgical outcome, and risk factors for conversion to tracheal intubation. Most patients (73% [n= 748]) were women, and 14.3% (n= 147) of all patients were smokers. The average body mass index was 22.6 kg/m2. We performed 315 lobectomies, 111 segmentectomies, and 598 wedge resections. Postoperative complications included prolonged air leak for more than 5 days (20 patients [2%]), arrhythmia (2 [0.2%]), hemothorax (3 [0.3%]), pneumonia (4 [0.4%]), and chylothorax (2 [0.2%]). No surgical deaths occurred. During the operation 20 patients (2%) were converted to tracheal intubation. The main reason for conversion was considerable mediastinal movement. Multivariable analysis revealed that a body mass index of 25 kg/m2 or higher (p < 0.001) and pulmonary anatomical resection (p < 0.001) were risk factors for conversion to intubation. Nonintubated thoracoscopic surgery was a safe and effective technique for lung tumor resection. Clinicians should be aware that patients with a body mass index of 25 kg/m2 or higher or who require pulmonary anatomical resection have a higher risk of conversion to tracheal intubation.