Anesthesia Comparison in Early-stage Small NSCLC: A Multicenter RCT
Comparison Between Spontaneous Breathing-preserving Anesthesia and Double-lumen Endotracheal Intubation Anesthesia in Early-stage Non-small Cell Lung Cancer With a Diameter of ≤ 3 cm: a Prospective, Multicenter Randomized Controlled Study
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Xiaolong Yan, Doctor of Medicine (M.D.)
- Phone Number: +8615991269383
- Email: yanxiaolong@fmmu.edu.cn
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Age ≤ 75 years;
- Gender is not limited;
- Patients with suspected T1 stage non-small cell lung cancer (NSCLC) in preoperative clinical staging, with thin-slice CT showing that the maximum tumor diameter is ≤ 3.0 cm, single or multiple nodules, and the nodules requiring surgical resection are located in the same ipsilateral lung lobe, with the number of nodules resected simultaneously ≤ 3;
- American Society of Anesthesiologists (ASA) classification ≤ Grade III (preferably Grade I - II is recommended);
- Eastern Cooperative Oncology Group (ECOG) performance status 0 - 1;
- Body Mass Index (BMI) < 25 kg·m-²;
- Normal cardiopulmonary function: predicted forced expiratory volume in the first second (FEV1%) > 50%, resting blood gas analysis showing arterial oxygen partial pressure (PaO2) ≥ 75 mmHg, arterial carbon dioxide partial pressure (PaCO2) < 45 mmHg; ejection fraction (EF) > 50%, 6-minute walk distance (6MWD) ≥ 350 m;
- No severe upper airway lesions, Mallampati classification I - II;
- No contraindications related to paravertebral nerve block and intercostal nerve block;
- Estimated surgical time ≤ 150 minutes;
- Patients have no history of clinically significant cardiac or neurological problems.
Exclusion Criteria:
- A history of ipsilateral lung surgery;
- Interstitial pneumonia, pulmonary fibrosis, severe emphysema, severe chronic obstructive pulmonary disease, acute phase of pulmonary infection, or uncontrolled asthma;
- Sleep apnea syndrome with anticipated airway difficulty or difficulty in airway management;
- Preoperative complications including coagulation dysfunction, hypoxemia, hypercapnia, or hepatic/renal insufficiency;
- Alteration of anesthesia or surgical plan;
- Persistent cough or increased risk of high airway secretion reflux;
- Mental disorders, inability to communicate, or refusal to sign the informed consent form;
- Participation in other clinical trials within 1 month before this trial;
- Those who are deemed unfit to participate in this trial by the researchers.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: group A
Non-intubated video-assisted thoracic surgery with spontaneous breathing (NIVATS)
|
NIVATS is a special method developed in the past two decades.
It means that patients do not undergo tracheal intubation under general anesthesia during the entire surgical process, retaining their spontaneous breathing, but supraglottic airway devices (such as laryngeal masks, high-flow nasal catheters, mask ventilation) can be used to support their breathing.
The purpose of this technology is to minimize the impact of general anesthesia, tracheal intubation, mechanical ventilation, etc. on patients.
|
|
Placebo Comparator: group B
Tracheal Intubation with One-Lung Ventilation Group (OLV)
|
NIVATS is a special method developed in the past two decades.
It means that patients do not undergo tracheal intubation under general anesthesia during the entire surgical process, retaining their spontaneous breathing, but supraglottic airway devices (such as laryngeal masks, high-flow nasal catheters, mask ventilation) can be used to support their breathing.
The purpose of this technology is to minimize the impact of general anesthesia, tracheal intubation, mechanical ventilation, etc. on patients.
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
Average postoperative hospital stay
Time Frame: up to 3 months
|
up to 3 months
|
|
Intraoperative opioid consumption
Time Frame: 1 day
|
1 day
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Lung collapse score
Time Frame: 1 day
|
1 day
|
|
|
Intraoperative blood gas analysis (Q1h)
Time Frame: 1 day
|
1 day
|
|
|
Conversion to intubation rate
Time Frame: 1 day
|
1 day
|
|
|
Postoperative awakening time
Time Frame: 1 day
|
1 day
|
|
|
Time to first ambulation after surgery
Time Frame: up to 3 months
|
up to 3 months
|
|
|
Ambulation rate within 4 hours after surgery
Time Frame: up to 3 months
|
up to 3 months
|
|
|
Inflammatory markers (IL-6, peripheral neutrophil-to-lymphocyte ratio)
Time Frame: up to 3 months
|
up to 3 months
|
|
|
Postoperative drainage volume
Time Frame: up to 3 months
|
up to 3 months
|
|
|
Incidence of perioperative complications
Time Frame: up to 3 months
|
Number of participants with treatment-related adverse events as assessed by CTCAE v4.0
|
up to 3 months
|
|
15 item Quality of Recovery Rating Scale (QoR-15)
Time Frame: up to 1 year
|
up to 1 year
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Time Frame |
|---|---|
|
The impact of nursing education on discharge time and time to first ambulation after surgery
Time Frame: up to 3 months
|
up to 3 months
|
|
Comparison of the effects of thoracic paravertebral nerve block and intrathoracic intercostal nerve block
Time Frame: up to 3 months
|
up to 3 months
|
|
1-, 3-, and 5-year disease-free survival (DFS)
Time Frame: up to 5 years
|
up to 5 years
|
|
1-, 3-, 5-, and 10-year overall survival (OS)
Time Frame: up to 10 years
|
up to 10 years
|
Collaborators and Investigators
Sponsor
Sponsor
Publications and helpful links
General Publications
- Pompeo E, Mineo D, Rogliani P, Sabato AF, Mineo TC. Feasibility and results of awake thoracoscopic resection of solitary pulmonary nodules. Ann Thorac Surg. 2004 Nov;78(5):1761-8. doi: 10.1016/j.athoracsur.2004.05.083.
- Pompeo E. State of the art and perspectives in non-intubated thoracic surgery. Ann Transl Med. 2014 Nov;2(11):106. doi: 10.3978/j.issn.2305-5839.2014.10.01.
- Chiang XH, Lin MW. Converting to Intubation During Non-intubated Thoracic Surgery: Incidence, Indication, Technique, and Prevention. Front Surg. 2021 Oct 26;8:769850. doi: 10.3389/fsurg.2021.769850. eCollection 2021.
- Lohser J, Slinger P. Lung Injury After One-Lung Ventilation: A Review of the Pathophysiologic Mechanisms Affecting the Ventilated and the Collapsed Lung. Anesth Analg. 2015 Aug;121(2):302-18. doi: 10.1213/ANE.0000000000000808.
- Hung WT, Hung MH, Wang ML, Cheng YJ, Hsu HH, Chen JS. Nonintubated Thoracoscopic Surgery for Lung Tumor: Seven Years' Experience With 1,025 Patients. Ann Thorac Surg. 2019 Jun;107(6):1607-1612. doi: 10.1016/j.athoracsur.2019.01.013. Epub 2019 Feb 11.
- Gelzinis TA, Sullivan EA. Non-Intubated General Anesthesia for Video-Assisted Thoracoscopic Surgery. J Cardiothorac Vasc Anesth. 2017 Apr;31(2):407-408. doi: 10.1053/j.jvca.2016.12.027. Epub 2016 Dec 23. No abstract available.
- Janik M, Juhos P, Lucenic M, Tarabova K. Non-intubated Thoracoscopic Surgery-Pros and Cons. Front Surg. 2021 Dec 6;8:801718. doi: 10.3389/fsurg.2021.801718. eCollection 2021.
- Liu J, Cui F, He J. Non-intubated video-assisted thoracoscopic surgery anatomical resections: a new perspective for treatment of lung cancer. Ann Transl Med. 2015 May;3(8):102. doi: 10.3978/j.issn.2305-5839.2015.04.18.
Study record dates
Study Major Dates
Study Start (Estimated)
Study Start
Primary Completion (Estimated)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- IIT202508-17-KYB-15-XWK
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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