Effects of dexmedetomidine on inflammation and pulmonary function after thoracoscopic surgery for lung cancer: a systematic review and meta-analysis

Abstract

Background Surgical resection is the most effective treatment for lung cancer, but it can also lead to adverse stress reactions in the body. The minimization of lung function damage caused by one-lung ventilation and inflammatory reactions caused by surgery are new challenges faced by the field of anesthesiology. Dexmedetomidine (Dex) has been found to be effective in improving perioperative lung function. In this study, we aimed to conduct a systematic review and meta-analysis to examine the effect of Dex on inflammation and pulmonary function after thoracoscopic surgery for lung cancer. Methods A computer-based search was performed to retrieve controlled trials (CTs) about the effects of Dex on inflammation and lung function after thoracoscopic surgery for lung cancer from the databases of PubMed, Embase, Cochrane Library, and Web of Science. The time period for retrieval was set from inception to 1 August 2022. The articles were strictly screened according to the inclusion and exclusion criteria, and data analysis was conducted using the software Stata 15.0. Results A total of 11 CTs were included, involving 1,026 patients overall, with 512 assigned to the Dex group and 514 to the control group. The meta-analysis showed that after Dex treatment, the inflammatory factors of patients with lung cancer who underwent radical resection were all decreased: interleukin-6 (IL-6) [standardized mean difference (SMD) =−2.09; 95% confidence interval (CI): −3.03, −1.14; P=0.003], interleukin-8 (IL-8) (SMD =−1.12; 95% CI: −1.54, −0.71; P=0.001), and tumor necrosis factor-α (TNF-α) (SMD =−2.04; 95% CI: −3.24, 0.84; P=0.001). The pulmonary function of the patients was also improved: forced expiratory volume in the first second (FEV1) (SMD =0.50; 95% CI: 0.24, 0.76; P=0.003), and partial pressure of oxygen (PaO 2 ) (SMD =1.00; 95% CI: 0.40, 1.59; P=0.001). However, there was no significant difference between the two groups regarding adverse reactions [relative risk (RR) =0.68; 95% CI: 0.41, 1.14; P=0.27]. Conclusions In summary, the use of Dex in lung cancer patients after radical surgery can reduce serum inflammatory factors, and this may play an important role in postoperative inflammatory reaction and improving lung function.

Trial watch: dexmedetomidine in cancer therapy

“…Two meta-analyses indicated that DEX administered during cancer surgery reduced the secretion of protumorigenic inflammatory cytokines such as IL-6 and TNF-α but increased the levels of circulating T cells. It should be noted that not all included RCTs have investigated DEX-mediated immunomodulation and its consequences on immunosurveillance 59 , 60 ( Figure 4 ). Very few RCTs aimed to evaluate the impact of DEX on recurrence-free survival or overall survival, yielding mostly inconclusive results.…”

“…Both meta-analyses concluded on a DEX-induced decrease in protumor and inflammatory cytokines such as CRP, IL-6, IL-8 and TNF-α. 59 , 60 Many other studies dealing with the surgical removal of various solid primary tumors demonstrated that patients receiving intravenous DEX during the perioperative period had an attenuated increase in glucocorticoid stress compared to the control group. 61–70 Interestingly, two trials observed that DEX affected the activity of the corticotropic axis by attenuating the concentrations of circulating catecholamines and adrenocorticotropic hormone (ACTH).…”