VATS lobectomy reduces cytokine responses compared with conventional surgery

doi:10.1016/S0003-4975(00)01258-3

The Annals of Thoracic Surgery

Volume 70, Issue 1, July 2000, Pages 243-247

https://doi.org/10.1016/S0003-4975(00)01258-3 Get rights and content

Abstract

Background. Video-assisted thoracic surgery (VATS) lobectomy for early lung cancer has been shown to be technically feasible. Comparative studies on laparoscopic versus open procedures indicate that laparoscopy may reduce inflammatory reactions as reflected by the lesser release of cytokines. We investigated the cytokine responses following VATS and conventional lobectomy for clinical stage I lung cancer.

Methods. Thirty-six patients with clinical stage I nonsmall cell lung cancer were studied. 18 patients underwent VATS lobectomy and the other 18 by conventional thoracotomy. There were no differences between the two groups with respect to age, gender, pulmonary function, smoking history, comorbidity, tumor size, and pathology. Plasma levels of tumor necrosis factor-α (TNF-α), interleukin (IL)-1β, IL-6, IL-8, and an antiinflammatory cytokine IL-10 were measured before surgery, at the end of the procedure, and 4, 8, 24, and 48 hours thereafter in all patients.

Results. There was no mortality or major complication in either group. Analgesic requirement was significantly less in the VATS group. Although the release of TNF-α and IL-1β were minimal after surgery in both groups, the levels of IL-6, IL-8, and IL-10 were elevated. IL-6 and IL-8 levels were significantly lower in the VATS group at the end of surgery than in the open group. In addition, reduced release of IL-10 was also observed in the VATS group shortly after surgery.

Conclusions. VATS lobectomy is associated with reduced postoperative release of both proinflammatory and antiinflammatory cytokines compared with the open approach. The clinical significance of these findings remains to be fully elucidated.

Section snippets

Material and methods

From January 1997 to December 1998, 38 patients with clinical stage I nonsmall cell lung cancer and tumor size less than 4 cm in maximal diameter were recruited into the study. There were 24 men and 14 women (mean age, 62 years; range, 53 to 88 years). Routine mediastinoscopy was performed on all patients, among whom 2 were diagnosed to have N2 disease. These 2 patients received neoadjuvant chemotherapy and were excluded from the final analysis. The remaining 36 patients underwent routine VATS

Results

Because of the design of the study, we finished recruiting the 18 patients in the VATS group before we finished with the open group (n = 18). There was no difference between the two groups with respect to preoperative pulmonary function (forced expiratory volume in 1 second and forced vital capacity), smoking history and comorbidity. No mortality or intraoperative complications were encountered in either group, and no conversion occurred in the VATS group. The demographics, nature of the

Comment

Our data suggests that in comparison with the conventional open approach, VATS lobectomy is associated with a lesser release of both proinflammatory and antiinflammatory cytokines, indicating a reduced as well as balanced postoperative inflammatory reaction.

Inflammatory response serves a protective function to the body that could become harmful when it reaches a pathologic and systemic level. Recent studies of laparoscopic versus open procedures demonstrate that the degree of such an

Acknowledgements

This work was supported by a grant from the Research Grant Council of the Hong Kong Special Administrative Region (CUHK 280/96 mol/L).

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Original articleVATS lobectomy reduces cytokine responses compared with conventional surgery

Abstract

Section snippets

Material and methods

Results

Comment

Acknowledgements

Am J Surg

Am J Obstet Gynecol

Surgery

Chest

J Thorac Cardiovasc Surg

Chest

Am J Surg

Ann Thorac Surg

Ann Thorac Surg

Chest

Semin Thorac Cardiovasc Surg

Semin Thorac Cardiovasc Surg

Original article
VATS lobectomy reduces cytokine responses compared with conventional surgery