Spontaneous ventilation video-assisted thoracoscopic surgery for octogenarian non-small cell lung cancer patients: a non-inferiority study

Background: The benefits of spontaneous ventilation (SV)-video-assisted thoracoscopic surgery (VATS) in octogenarian patients with non-small-cell lung cancer (NSCLC) have rarely been reported. This retrospective study was conducted to evaluate the safety and feasibility of SV-VATS in octogenarian patients with NSCLC. Methods: Patients with NSCLC aged >80 years who underwent SV-VATS or mechanical ventilation (MV)-VATS between 2017 and 2022 were included in this study. The baseline characteristics of the two groups were balanced by a 1:2 propensity score matching (PSM). Intraoperative and postoperative outcomes were compared. Overall survival (OS) and disease-free survival (DFS) were analyzed by Kaplan-Meier survival analysis and Cox regression. Results: A total of 251 patients were initially included, and after applying selection criteria and PSM, 22 patients were in the SV-VATS group and 44 in the MV-VATS group. Baseline characteristics were well balanced between the two groups. Compared with the MV-VATS group, the SV-VATS group had shorter post-anesthesia care unit (PACU) stay (88.8 +/- 22.3 vs. 111 +/- 38.8, P=0.01) and shorter resuscitation time (88.8 +/- 22.7 vs. 112 +/- 40.4, P=0.02). No statistically significant differences were observed in the surgical and anaesthesia times, chest tube duration, total volume of chest drainage, intraoperative blood loss, postoperative hospital stay, or complications in the PACU. The OS and DFS of patients who underwent SV-VATS were comparable to those of patients who underwent MV-VATS. Conclusions: SV-VATS appears to be a safe and feasible option for octogenarian patients with NSCLC, providing a new approach to surgical treatment. Large-scale prospective studies are required to further validate its feasibility.