title: Non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia for thoracic surgery: a meta-analysis.
abstract: The short-term feasibility and safety of non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia for thoracic surgery remains unknown. Therefore, we conducted a meta-analysis to provide evidence for the short-term efficacy and safety profile of non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia for thoracic surgery.
  
  
  
  We performed a systematic literature search in PubMed, Embase, Cochrane Library databases and Google Scholar, as well as American Society of Clinical Oncology to identify relevant studies comparing non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia with conventionally intubated video-assisted thoracoscopic surgery under general anaesthesia, dated up to 31 August 2015. Data concerning global in-operating room time, hospital stays, rate of postoperative complications and perioperative mortality were extracted and analysed. We conducted a meta-analysis of the overall results and two subgroup analyses based on study design (a meta-analysis of randomized controlled trials and a second meta-analysis of observational studies).
  
  
  
  Four randomized controlled trials and six observational studies with a total of 1283 patients were included. We found that in the overall analysis, patients treated with non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia achieved significantly shorter global in-operating room time [weighted mean difference = -41.96; 95% confidence interval (CI) = (-57.26, -26.67); P < 0.001] and hospital stays [weighted mean difference = -1.24; 95% CI = (-1.46, -1.02); P < 0.001] as well as a lower rate of postoperative complications [relative risk = 0.55; 95% CI = (0.40, 0.74); P < 0.001] than patients treated with intubated video-assisted thoracoscopic surgery under general anaesthesia. Subgroup meta-analyses based on study design achieved the same outcomes as overall analysis. In our meta-analysis, no perioperative mortality was observed in patients treated with non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia.
  
  
  
  Non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia for thoracic surgery proved to be feasible and safe. Future multicentre and well-designed randomized controlled trials with longer follow-up are needed to confirm and update the findings of our study, as well as the long-term efficacy of non-intubated video-assisted thoracoscopic surgery under loco-regional anaesthesia.
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Han-Yu
authors.initials: HY
authors.lastname: Deng
authors.affiliation: Department of Thoracic Surgery, Gansu Provincial Hospital, Gansu, China.
authors.forename: Zi-Jiang
authors.initials: ZJ
authors.lastname: Zhu
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Yun-Cang
authors.initials: YC
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
authors.forename: Peng-Zhi
authors.initials: PZ
authors.lastname: Ni
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, Chengdu, Sichuan, China drchenlq@gmail.com.
authors.forename: Long-Qi
authors.initials: LQ
authors.lastname: Chen
mesh_terms: D000765:Anesthesia, Conduction; D000768:Anesthesia, General; D006801:Humans; D007442:Intubation, Intratracheal; D007902:Length of Stay; D011183:Postoperative Complications / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D020775:Thoracic Surgery, Video-Assisted
keywords: Anaesthesia; Meta-analysis; Non-intubated; Thoracic surgery; Video-assisted thoracoscopic surgery