Comparison of awake and intubated video-assisted thoracoscopic surgery in management of malignant pleural effusion

Abstract Objectives: The aim of this study was to evaluate the efficacy and safety of the short-term postoperative outcomes with patients underwent awake and intubated video assisted thoracoscopic surgery in the management of recurrent malignant pleural effusion. Background: Malignant pleural effusion is characterized by presence of malignant cells in the pleural fluid. Malignant cells from pleural lavage performed in patients without a coexistent pleural effusion have been identified as an indicator of micro-metastatic disease and are associated with a higher recurrence rate and poorer survival. Patients and methods: A case series of 315 consecutive patients from January 2021 to November 2023 with malignant pleural effusion. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated as group A) and video-assisted thoracoscopic surgery with general anesthesia (intubated as group B). The patients’ demographics and co-morbid conditions were noted, which are associated with postoperative complications and morbidity. Results: The study included 315 patients which underwent video assisted thoracoscopic pleurodesis either by endotracheal intubation (145 cases) or without (170 cases). The mean average age was noted to be 54.58 ± 7.93. there were 178 cases of male patients (65.5 %). There was highly significant differences in both parameters (p< 0.001). VAS showed significant difference after procedure 4 hours without any difference after 24 hours. There was non-significant difference between both groups according to changes of dyspnea score and grades of chest X-ray findings of pleural effusion. Conclusion: Awake video-assisted thoracoscopic surgery is safe in patients especially those with co-morbidity and couldn’t tolerate general anesthesia. It has also similar reliability compared to video-assisted thoracoscopic surgery performed under general anesthesia.