Article Abstract

Immune effects after uniportal nonintubated video-thoracoscopic operations

Authors: Tommaso Claudio Mineo, Vincenzo Ambrogi


Background: We hypothesized that uniportal video-assisted thoracic surgery (VATS) under nonintubated anesthesia may have a lesser immunological impact than same procedures under general anesthesia.
Methods: Between December 2005 and October 2016, a total of consecutive 878 patients underwent VATS operations under nonintubated anesthesia. In a subset of 542 patients we assessed lymphocyte subpopulations at 1, 7 and 14 days postoperatively and matched with a control group of 106 patients who underwent uniportal intubated surgery.
Results: Global time spent in the operative room was significantly longer in intubated group (85±41 vs. 118±34 minutes; P=0.03). The total lymphocytes count showed a lesser drop in the nonintubated group at post-operative day 7 (P=0.04) and 14 (P=0.05) with a significant lesser reduction of natural killer lymphocytes at day 7 (P=0.03) and 14 (P=0.04). 30-day mortality (0.9% vs. 4.7%; P=0.04), major morbidity (9.5% vs. 19%; P=0.03) and hospital stay (4.2±2.8 vs. 6.1±2.6 days; P=0.04) were significantly lower in the nonintubated group. Survival rate in the subset of patients operated for malignant effusion was significantly higher in the nonintubated group (P=0.03).
Conclusions: Uniportal nonintubated operations demonstrated a significant lower impact on immunological response compared to the traditional procedure in general anesthesia. This impacted postoperative 30-day mortality, major morbidity and hospital stay. We also found a significant influence on long-term survival in a consistent subset of patients operated for malignant pleural effusion.