Is Less More? A Meta-Analysis of Non-Intubated Versus Intubated VATS for Anatomic Resections in Non-Small Cell Lung Cancer
Bibliographic record
Abstract
Objective: Non-intubated video-assisted thoracoscopic surgery (NIVATS) has emerged as a less invasive alternative to conventional intubated VATS (IVATS) for patients undergoing lobectomy for non-small cell lung cancer (NSCLC). However, concerns regarding its safety, efficacy, and oncologic adequacy remain. This meta-analysis aimed to compare perioperative and short-term outcomes between NIVATS and IVATS. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. PubMed, Scopus, and Cochrane CENTRAL were searched through 30 June 2025. Studies comparing NIVATS and IVATS for anatomical lung resections (lobectomy and/or segmentectomy) in NSCLC were included; wedge resections were excluded. Primary endpoints included postoperative complications, operative time, intraoperative blood loss, lymph node yield, and 30-day mortality. Secondary endpoints were chest tube duration, hospital length of stay, anesthetic time, and conversion to thoracotomy rates. Risk of bias was assessed primarily with ROBINS-I; the Newcastle–Ottawa Scale was applied for sensitivity. Results: A total of seven studies (six retrospective and one randomized controlled trial) encompassing 851 patients (374 NIVATS, 477 IVATS) were included. NIVATS was associated with a significantly lower rate of postoperative complications (OR 0.50; 95% CI: 0.30–0.86; p = 0.01; I2 = 0%), shorter operative time (minutes) (WMD −21.85; 95% CI: −38.49, −5.21; p = 0.01), anesthetic time (minutes) (WMD −4.62; 95% CI: −6.60, −2.65; p < 0.01), and reduced intraoperative blood loss (mL) (WMD −24.36; 95% CI: −30.67, −18.05; p < 0.01). There were no significant differences in lymph node yield or conversion to thoracotomy rates. No 30-day mortality was reported in either group. The quality of included studies was moderate, and publication bias was not evident. Conclusions: NIVATS appears to be a safe and effective alternative to IVATS in selected patients undergoing lobectomy for NSCLC. It offers improved perioperative outcomes without compromising surgical or oncologic standards. Prospective trials are needed to confirm these findings and assess long-term survival.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.021 | 0.039 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.018 | 0.069 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".