Awake thoracic surgery for lung cancer treatment: where we are and future perspectives-our experience and review of literature.

Background: Lung cancer is the first cause of cancer-related death. Awake lung resection is a new frontier of the concept of minimally invasive surgery. Our purpose is to demonstrate the feasibility of this technique for lobar and sublobar lung resection in NSCLC patients.

Methods: We retrospective reviewed all the medical charts of patients who underwent awake lung resection in our center between March 2018 and March 2024, focusing on patients with NSCLC, and we compared our results with the ones found in literature.

Results: Among 45 patients treated with awake lung resections, we selected 15 patients with NSCLC and finally analyzed the results of 12 patients who underwent VATS awake lung resection, 3 lobectomies and 9 wedge resections. The median Charlson comorbidity index (CCI) was 3 and we had 5 patients (41.67%) with a CCI ≥ 4 and a median FEV1 of 56%. We report only 2 conversions to general anesthesia (16.67%) and no conversion to open thoracotomy. We used a nebulizator for the atomization of lidocaine on the lung surface to reduce the cough reflex. Our post-operative results are in line with literature, with a low complication rate (2 patients, 16.67%) and a median length of stay of 5 days. We safely performed a proper lymph node dissection in all 3 lobectomies. Median Overall Survival and Disease-Free Survival were 11 months.

Conclusions: Awake lung resections are a feasible way to perform a minimally invasive surgical procedure in NSCLC patients, with low risk of conversion to open surgery.