Perioperative Outcomes of Non-Intubated Versus Intubated Anesthesia in Video-Assisted Thoracoscopic Surgery for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matched Analysis

Hsiang-Han Huang; Li-Hua Chen; Hou-Chuan Lai; Zhi-Fu Wu; Ching-Lung Ko; Kai-Li Lo; Go-Shine Huang; Wei-Cheng Tseng

doi:10.3390/jcm14103466

Perioperative Outcomes of Non-Intubated Versus Intubated Anesthesia in Video-Assisted Thoracoscopic Surgery for Early-Stage Non-Small Cell Lung Cancer: A Propensity Score-Matched Analysis

J Clin Med. 2025 May 15;14(10):3466. doi: 10.3390/jcm14103466.

Authors

Hsiang-Han Huang¹, Li-Hua Chen^{1

2}, Hou-Chuan Lai¹, Zhi-Fu Wu^{1

3

4

5}, Ching-Lung Ko^{1

6}, Kai-Li Lo^{1

6}, Go-Shine Huang¹, Wei-Cheng Tseng¹

Affiliations

¹ Department of Anesthesiology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan.
² Graduate Institute of Public Health, National Defense Medical Center, Taipei 114, Taiwan.
³ Department of Anesthesiology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
⁴ Department of Anesthesiology, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
⁵ Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
⁶ Graduate Institute of Life Sciences, National Defense Medical Center, Taipei 114, Taiwan.

Abstract

Background: Previous studies have shown that ventilation strategies used in general anesthesia influence perioperative outcomes of video-assisted thoracoscopic surgery (VATS). This study investigated the perioperative effects of non-intubated anesthesia (NIA) versus intubated anesthesia (IA) in patients with early-stage non-small cell lung cancer (NSCLC) undergoing VATS. Methods: This retrospective cohort study analyzed patients who underwent elective VATS for early-stage NSCLC between January 2015 and December 2022. Patients were categorized into the NIA and IA groups based on the ventilation strategies during general anesthesia. Comprehensive outcome data, including intraoperative and postoperative variables, were compared between the two groups. Univariate and multivariate logistic regression models were used to assess the odds ratios for conversion from NIA to IA. Results: A total of 372 patients who received NIA and 1560 who received IA for VATS were eligible for analysis. After propensity score matching, 336 patients were included in each group. In the matched analysis, patients who received NIA demonstrated favorable perioperative outcomes, including reduced opioid consumption, lower postoperative complication rates, and shorter hospital stays, compared to those who received IA. Additionally, patients with a lower baseline oxygen saturation and those who experienced intraoperative pulmonary and cardiovascular adverse events had a higher risk of conversion from NIA to IA. Conclusions: NIA during VATS in patients with early-stage NSCLC was associated with superior perioperative outcomes. Prospective studies are warranted to further evaluate the impact of NIA on perioperative outcomes in this patient population.

Keywords: double-lumen tube; intubated anesthesia; laryngeal mask airway; non-intubated anesthesia; non-small cell lung cancer; video-assisted thoracoscopic surgery.