Thoracoscopic Lobectomy Using Thoracic Epidural Anesthesia Versus General Anesthesia for Lung Cancer Patients

• Comparing the safety after intervention of each group. [ Time Frame: 1 month ] [ Designated as safety issue: Yes ]
  Comparing the complication and morbidity after intervention of each group
  
  

• Short-term outcome [ Time Frame: one month ] [ Designated as safety issue: Yes ]
  including ICU stay, period of ventilator use, hospital stay, number of days with chest drainage, adverse events, etc.
  
  
• Oncological outcome [ Time Frame: 5 years ] [ Designated as safety issue: No ]
  Number of LN dissection and overall survival after the operation
  
  

Lung cancer is the leading cause of cancer death in Taiwan. Traditionally, open thoracotomy has been the standard approach for lung cancer surgery, including lobectomy and pneumonectomy. With the advance of thoracoscopic technique, thoracoscopic lobectomy has emerged as a reasonable option for the management of early-stage non-small cell lung cancer (NSCLC), and is supported by evidence-based treatment guidelines. Advantages of thoracoscopic lobectomy compared with thoracotomy include less postoperative pain, shorter hospitalization, and decreased postoperative pulmonary complications.

Traditionally, general anesthesia (GA) with one-lung ventilation using double-lumen endotracheal intubation has been considered mandatory in both open and thoracoscopic surgery. However, adverse effects of GA may occur after the operation, including ventilator-induced lung injury, impaired cardiac performance, postoperative nausea and vomiting, and residual neuromuscular blockade.

In order to reduce the adverse effects of GA, thoracic epidural anesthesia (TEA) has been recently employed to perform awake thoracic surgery procedures including coronary artery bypass, management of pneumothorax, resection of pulmonary nodules and solitary metastases, lung volume reduction (LVR), and even transsternal thymectomy. The results achieved in these early series have been encouraging. In Taiwan, awake thoracic surgery has also been performed at Taipei Veteran General Hospital in a high risk patient with satisfactory results.

The role of TEA in thoracoscopic lobectomy is rarely investigated. There is a report showed that lobectomy using TEA is safe and feasible, although only 3 cases were reported [13]. In our hospital, we also performed 6 thoracoscopic lobectomy using TEA between August and October, 2009 with satisfactory results. Until now, the safety and effects of TEA in thoracoscopic lobectomy has been unclear and comparison between TEA and GA has never been performed. We hypothesize that thoracoscopic lobectomy using TEA will be associated with a comparable oncological results, lower cardiopulmonary complications, and shorter intensive care unit (ICU) and hospital stays. To this end, we will compare safety and results of thoracoscopic lobectomy using thoracic epidural anesthesia versus GA for lung cancer patients.

This study will be performed at National Taiwan University Hospital. A total of 100 patients will be included (50 patients in each arm).