Immune profiling after minimally invasive lobectomy

Abstract

OBJECTIVES Whether acute phase and immune responses are minimally affected following minimally invasive lung surgery needs further investigation. We performed a pilot study to evaluate the immune profile of patients who underwent video-assisted thoracoscopic surgery or robot-assisted thoracic surgery lobectomies for the treatment of suspicious or known stage I non-small-cell lung cancer. METHODS Blood samples were taken preoperatively and 3 and 24 h postoperatively were analysed for C-reactive protein, glucose, cortisol, tumour necrosis factor alpha (TNF-α), interleukin 8 (IL-8) and interleukin 10 (IL-10) levels. TNF-α, IL-8 and IL-10 were also measured in lung tissues. T (CD4, CD8), B (CD19) and natural killer (CD56, CD16) cell counts and natural killer cell functions were analysed using a flow cytometry-based assay before and after surgery. RESULTS Minimally invasive surgery (robot-assisted thoracic surgery + video-assisted thoracoscopic surgery) significantly decreased IL-10 (P = 0.016) levels after surgery. No significant differences were detected in TNF-α (P = 0.48) and IL-8 (P = 0.15) levels before and after surgery. C-reactive protein (P < 0.001), cortisol (P < 0.001) and glucose levels (P < 0.001) increased significantly after surgery. Lymphocyte, total T cell, CD3+CD4+ and CD3+CD8+ CD16+CD56+ cell counts were significantly lower on postoperative day 1. CONCLUSION There seems to be a dynamic balance between pro- and anti-inflammatory cytokines and immune cells following minimally invasive lobectomy.

Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery

“…Our results suggest VATS induces a more pronounced inflammatory response than robot-assisted, as demonstrated by measurements of pro-inflammatory cytokines IL-6 and MCP-1 (27,28). These particular findings suggest a greater degree of surgical trauma-induced systemic inflammation as the VATS elevated cytokines have all been strongly associated with thoracic surgery trauma (11)(12)(13). Indeed, elevated of pro-inflammatory cytokines, such as IL-6, have been extensively correlated with the degree of cutaneous trauma and subsequently elicited systemic inflammation throughout the repair process (29)(30)(31)(32).…”

“…In terms of design and control, our study seemed to have benefited from surgeon consistency as, unlike the majority of previous studies, we had no difference in operation time between VATS and robotic (3,(21)(22)(23)(24)(25). Additionally, while select previous studies presented statistically significant inter-cohort age differences, we found no difference between our robotic and VATS cohorts (13,26). Thus, we were able to more adequately isolate surgical approach as our exposure variable.…”

“…Inflammatory cytokines in robot-assisted thoracic surgery versus video-assisted thoracic surgery in terms of clinical outcomes and cost (4)(5)(6)(7)(8)(9)(10). Several early studies have suggested that the VATS approach is associated with lesser release of cytokines and pro-inflammatory mediators, and that may be responsible for many of the benefits of minimally invasive thoracic surgery over open thoracotomy (11)(12)(13). It is plausible, that as a minimally invasive approach, the robotic approach would also have lower cytokine and pro-inflammatory mediator release.…”

“…However, it is unknown whether the robot-assisted technique is associated with similar or lower proinflammatory mediator release compared to VATS. Despite numerous studies comparing the link between perioperative systemic inflammation and morbidity and mortality in VATS versus open thoracotomy, the same comparison has seldom been studied between VATS and the robotic approach (11)(12)(13). The more precise dissection afforded by the improved 3-dimensional visualization with the robot may be associated with less tissue trauma and less cytokine release.…”

Perioperative Systemic Inflammation in Lung Cancer Surgery

“…The perioperative results of RATS are similar to those of the VATS, as noted in a meta-analysis ( 40 ), but the length of the surgery in some cases can be longer after RATS than after VATS. There were no differences in acute phase proteins and immune responses between the RATS and VATS procedures ( 41 ), showing that surgical trauma is similar in the two MITS methods.…”