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OBJECTIVES The feasibility and safety of spontaneous ventilation (SV) video-assisted thoracoscopic surgery (VATS) for non-small-cell lung cancer (NSCLC) in patients with excess body weight [defined as body mass index (BMI) ≥ 25 kg/m2] remain unclear. METHODS Patients with NSCLC with excess body weight who underwent SV-VATS or mechanical ventilation (MV) VATS (MV-VATS) between April 2012 and July 2018 were analysed retrospectively. Propensity score matching was applied to balance the distribution of demographic characteristics. The short-term outcomes between the SV-VATS group and MV-VATS group were compared. RESULTS From April 2012 to July 2018, a total of 703 patients with excess body weight were included, 68 of whom underwent SV-VATS and 635 of whom underwent MV-VATS. After propensity score matching, the distribution of demographic characteristics was well balanced. BMIs (26.65 ± 1.74 vs 27.18 ± 2.36 kg/m2; P = 0.29) were similar between the groups. Patients who underwent SV-VATS had similar anaesthesia times (213 ± 57 vs 233 ± 67 min; P = 0.16) and similar operative times (122 ± 44 vs 142 ± 56 min; P = 0.086). The intraoperative bleeding volume, postoperative chest tube duration, volume of pleural drainage, number of dissected N1 and N2 station lymph nodes, length of hospitalization and incidence of complications were comparable between the 2 groups. CONCLUSIONS Primary lung cancer resection is feasible and not associated with safety issues under SV-VATS in selected patients with NSCLC with excess body weight.

Spontaneous ventilation video-assisted thoracoscopic surgery for patients with non-small-cell lung cancer with excess body weight