Non-intubated video-assisted pulmonary metastasectomy: a narrative literature review

Objective: Due to the lack of extensive studies and unanimous consensus, the objective of this review is to analyze and report the most significant experiences in the treatment of lung metastasis with a minimally invasive approach and non-intubated surgery. Background: Pulmonary metastases are a sign of advanced malignancy and an indicator of poor prognosis. Surgical resection of lung metastases is commonly indicated for patients with controlled primary cancer, absence of widely disseminated extrapulmonary disease, completely resectable lung metastases, and lack of a better alternative systemic therapy. Over the last 20 years, minimally invasive techniques and video-assisted thoracoscopic surgery (VATS) have become the preferred surgical approach for the treatment of several lung diseases and have likewise carved out a role in surgery for pulmonary metastasis in appropriately selected patients. More recently, VATS under non-intubated anesthesia has gained a growing interest among thoracic surgeons showing several potential advantages over traditional intubated open and VATS approaches, quick patients' recovery, less postoperative pain, shorter length of hospitalization, and lower immunologic and inflammatory response are among its advantages. Non-intubated thoracic surgery (NITS) seems a valid alternative for patients with a high comorbidity index or elevated risk for general anesthesia. Methods: A narrative literature review was conducted resulting from an analysis of the literature limited to peer-reviewed studies. Conclusions: To date, few studies assess the application of non-intubated VATS (NI-VATS) for lung metastasectomy, however, preliminary results seem to show that NI-VATS can be considered a potentially valid alternative to the conventional approach in very selected patients.