Clinical evaluation of non-intubated spontaneous ventilation video-assisted thoracoscopic surgery in patients with non-small cell lung cancer and compromised pulmonary function: a propensity score-matched analysis

Abstract Objectives This study was designed to assess the feasibility and safety of non-intubated spontaneous ventilation video-assisted thoracoscopic surgery (VATS) in patients diagnosed with non-small cell lung cancer (NSCLC) and compromised pulmonary function. Methods A retrospective analysis was conducted on a cohort of 162 patients with NSCLC and impaired pulmonary function who underwent either non-intubated video-assisted thoracoscopic surgery (NIVATS, n = 86) or intubated video-assisted thoracoscopic surgery (VATS, n = 76) between January 2021 and May 2025. In the NIVATS group, surgical procedures included 37 lobectomies (48.7%) and 39 segmentectomies or wedge resections (51.3%), whereas the intubated VATS group underwent 46 lobectomies (53.5%) and 40 segmentectomies or wedge resections (46.5%). To control for potential confounding factors, 1:1 propensity score matching (PSM) was performed, resulting in two balanced groups of 62 patients each with comparable baseline characteristics. Short-term surgical outcomes were then compared between the two groups. Results Following propensity score matching, no statistically significant differences were observed between the non-intubated and intubated VATS groups in terms of surgical duration, anesthesia time, procalcitonin (PCT) levels, or cardiovascular complications. However, significant differences were observed in several postoperative outcomes, including duration of chest tube placement (2.66 ± 3.35 vs. 3.53 ± 2.39 days; p = 0.001), post-anesthesia awakening time (7.98 ± 2.55 vs. 15.69 ± 3.68 minutes; p < 0.001), incidence of hypoxemia and hypercapnia, postoperative bowel function (assessed by time to flatus and defecation), length of hospital stay, incidence of throat discomfort, postoperative pulmonary complications, and patient-reported postoperative satisfaction. Conclusions Non-intubated VATS is a feasible and safe alternative to conventional intubated VATS in carefully selected patients with NSCLC and compromised pulmonary function. This technique may facilitate enhanced postoperative recovery and represents a viable management option for specific patient populations.