Perioperative And Long-term Outcomes Of Spontaneous Ventilation Video-assisted Thoracoscopic Surgery For Non-small Cell Lung Cancer

Background: Spontaneous ventilation video-assisted thoracoscopic surgery(SV-VATS)exhibits dual intraoperative and postoperative advantages for patients with non-small cell lung cancer(NSCLC).However,there is a lack of data regarding its long-term survival superiority over the double-lumen intubated mechanical ventilation video-assisted thoracoscopic surgery(MV-VATS)or thoracotomy.Methods: A retrospective study was conducted from 2011 to 2018 in the First Affiliated Hospital of Guangzhou Medical University among patients with NSCLC who underwent the SV-VATS or the MVVATS.Patients receiving the SV-VATS were the study group,and patients receiving the MV-VATS were the control group.Propensity score matching(PSM)was performed to establish 1:1 SV-VATS versus MVVATS group matching to balance potential baseline confounding factors.Primary endpoints were overall survival(OS)and disease-free survival(DFS).Secondary endpoints were perioperative outcomes.The baseline information of these patients was recorded.The perioperative data and survival data were collected using a combination of electronic data record system and telephone interview.Results: For the two-group comparison,after 1:1 PSM,a matched cohort with400(200:200)patients was generated.The median follow-up time in this cohort was4.78 years(IQR,3.78–6.62 years).The OS(HR =0.567,95% CI,0.330 to 0.974,P=0.0498)and the DFS(HR =0.546,95% CI,0.346 to 0.863,P=0.013)of the SV-VATS group were significantly better than the MV-VATS group.There were no statistically differences between the SV-VATS and the MV-VATS group on the operative time(158.56±40.09 vs.172.06±61.75,P=0.200)anesthesia time(247.4±62.49 vs.256.7±58.52,P=0.528),and intraoperative bleeding volume(78.88±80.25 vs.109.932±180.86,P=0.092).Platelets after operation(U=13152.000,P=0.031),neutrophils after operation(U=12585.500,P=0.006),SII(system immune-inflammation index)after operation(U=12263.5,P=0.002),the difference of SII between before operation and after operaion(U=12340.000,P=0.003),NLR(neutrophil-to-lymphocyte ratio)(U=13037.000,P=0.023)after operation and the difference of NLR between before operation and after operaion(U=12882.500,P=0.015)of SV-VATS were smaller than the MV-VATS group.There is no difference of lymphocytes after operation between the SV-VATS and the MV-VATS group(U=13848.500,P=0.155).Conclusions: Invasive NSCLC patients undergoing SV-VATS lobectomy demonstrated better long-term outcomes compared with MV-VATS.