VATS lobectomy reduces cytokine responses compared with conventional surgery.
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-alpha (TNF-alpha), interleukin (IL)-1beta, 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-alpha and IL-1beta 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.
Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital. yimap@cuhk.edu.hk
A P
AP
Yim
S
S
Wan
T W
TW
Lee
A A
AA
Arifi
D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007378:Interleukins / Q000097:blood*; D008175:Lung Neoplasms / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000379:methods*; D020775:Thoracic Surgery, Video-Assisted; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*
D007378:Interleukins; D014409:Tumor Necrosis Factor-alpha