Innate Immune Responses after Resection for Lung Cancer via Video-Assisted Thoracoscopic Surgery and Thoracotomy

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Innate immune responses to pulmonary resection may be critical in the pathogenesis of important postoperative pulmonary complications and potentially longer-term survival. We sought to compare innate immunity of patients undergoing major pulmonary resection for bronchogenic carcinoma via video-assisted thoracoscopic surgery (VATS) and thoracotomy. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> Bronchoalveolar lavage was conducted in the contralateral lung before staging bronchoscopy and mediastinoscopy and immediately after lung resection. Blood and exhaled nitric oxide were sampled preoperatively and at 6, 24, and 48 hours postoperatively. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Forty patients were included (26 VATS and 14 thoracotomy). There was a lower systemic cytokine response from lung resection undertaken by VATS compared with thoracotomy [interleukin 6 (IL-6), analysis of variance (ANOVA) P = 0.026; IL-8, ANOVA P = 0.018; and IL-10, ANOVA P = 0.047]. The VATS patients had higher perioperative serum albumin levels (ANOVA P = 0.001). Lower levels of IL-10 were produced by lipopolysaccharide-stimulated blood monocytes from the VATS patients compared with the thoracotomy patients at 6 hours postoperatively (geometric mean ratio, 1.16; 95% confidence interval, 1.08–1.33; P = 0.011). No statistically significant differences in the neutrophil phagocytic capacity, overall leukocyte count, or differential leukocyte count were found between the surgical groups (ANOVA P &gt; 0.05). No statistically significant differences in bronchoalveolar lavage fluid parameters were found. Exhaled nitric oxide levels fell postoperatively, which reached statistical significance at 48 hours (geometric mean ratio, 1.2; 95% confidence interval, 1.02–1.46; P = 0.029). There were no significant differences found between the surgical groups (ANOVA P = 0.331). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Overall, a trend toward greater proinflammatory and anti-inflammatory responses is seen with lung resection performed via thoracotomy compared with VATS. </jats:p></jats:sec>

Perioperative cytokine profile during lung surgery predicts patients at risk for postoperative complications—A prospective, clinical study

“…Patients undergoing lung surgery via thoracotomy had a higher rate of postoperative complications and increased plasma concentrations of IL-6, IL-8 and IL-10. [ 18 , 19 ] In accordance with these results patients in the complication group with higher plasma concentrations of IL-6, IL-8 and IL-10 underwent thoracotomy more often (86% versus 58%). We measured IL-6 and IL-10 plasma concentrations at the time of wound closure and on the first postoperative day as most complications occur quite early on the second or even first postoperative day.…”

Postoperative Regulatory T-Cells and Natural Killer Cells in Stage I Nonsmall Cell Lung Cancer Underwent Video-assisted Thoracoscopic Lobectomy or Thoracotomy

“…[ 30 31 ] Notably, differences in nearly all of the postoperative cytokines and plasma immunomodulatory mediators measured thus far between VATS and thoracotomy groups are short-lived, in the order of hours to a couple of days. [ 7 8 ] In our study, on PODs 1, 3, 7, 30, NK cell numbers were found to be significantly higher following VATS lobectomy compared to the open approach, suggesting that VATS is associated with less inhibition and quicker recovery of NK cell than conventional thoracotomy. The rationale behind remains to be fully elucidated and actually encompasses numerous factors, including reduced acute-phase cytokine responses and postoperative pain, differences in patient expectations, and possible psychological effects.…”

“…Less immune disturbance after VATS lobectomy was previously shown in several researches on plasma immunomodulatory mediators[ 7 8 ] and NK cells. [ 30 31 ] Notably, differences in nearly all of the postoperative cytokines and plasma immunomodulatory mediators measured thus far between VATS and thoracotomy groups are short-lived, in the order of hours to a couple of days.…”

“…However, in VATS group, Treg proportion on POD 90 was found statistically lower than that in thoracotomy group. It may be explained that the diminished surgical trauma by VATS approach does not change the Treg level directly, but gradually induces less immune disturbance in multiple ways[ 7 8 30 31 ] and hence inhibits Treg for a longer time.…”

“…[ 4 5 6 ] Interest has developed on whether VATS preserves better immune status and benefits long-term survival. [ 7 8 ] Regulatory T-cell (Treg), known as a negative regulator of the cellular immunity, has been considered as a negative prognostic factor for cancer progression. Little is known[ 9 ] on the influence of lobectomy on Treg population in lung cancer patients.…”