Short-term and Long-Term Outcomes of Non-Tracheal Intubation Anesthesia in Thoracoscopic Lobectomy for Lung Cancer: A Systematic Review and Meta-Analysis.

The present study compared the efficacy and safety of non-intubated video-assisted thoracoscopic surgery (NIVATS) with intubated video-assisted thoracoscopic surgery (IVATS) for lobectomy in the treatment of lung cancer through a systematic review and meta-analysis. A total of six electronic databases were searched for studies comparing NIVATS and IVATS published up to October 2024. After rigorous screening and quality assessment, perioperative outcomes and postoperative complications were systematically analyzed from 18 studies, comprising three randomized controlled trials, six propensity score-matched studies and nine retrospective studies. A total of 2,313 patients with lung cancer underwent thoracoscopic lobectomy, of whom 1,082 underwent NIVATS and 1,231 underwent IVATS. The results revealed that NIVATS significantly reduced operative time [mean difference (MD)=11.02; 95% confidence interval (CI), -18.78 to -3.27], lymph nodes harvested (MD=-0.67; 95% CI, -1.24 to -0.11), anesthesia waking time (MD=-22.88; 95% CI, -33.13 to -12.64), feeding time (MD=-4.53; 95% CI, -5.74 to -3.32), chest tube indwelling time (MD=-0.68; 95% CI, -1.16 to -0.21) and hospital stay (MD=-1.16; 95% CI, -1.57 to -0.74) compared with the IVATS group. Total complications [odds ratio (OR)=0.53; 95% CI, 0.31 to 0.90], particularly sore throat (OR=0.18; 95% CI, 0.10 to 0.33) and pneumonia (OR=0.54; 95% CI=0.30 to 0.98) were significantly lower in the NIVATS group than in the IVATS group. Re-intubation occurred in 4.33% of NIVATS patients, while conversion to thoracotomy rates were similarly low in the NIVATS (0.69%) and IVATS (0.60%) groups. Importantly, NIVATS was associated with significantly improved overall survival [hazard ratio (HR)=0.63; 95% CI, 0.40 to 0.98] and recurrence-free survival (HR=0.62; 95% CI, 0.46 to 0.85). No significant differences were observed for anesthesia time, blood loss, hoarseness, air leakage or arrhythmia. Under the enhanced recovery after surgery framework, NIVATS appears to be a safe and technically feasible alternative to IVATS, with the potential to improve patient outcomes based on the available evidence. Its clinical adoption is supported by the evidence in the present study, offering a basis for informed decision-making.