Immunologic and stress responses following video-assisted thoracic surgery and open pulmonary lobectomy in early stage lung cancer.
Conventional open major surgery evokes an injury response involving endocrine, neural, and immunologic mechanisms. The immunologic responses are characterized by release of cytokines, inflammatory mediators, and acute-phase proteins and by adverse disturbances in immune cell function. The use of a minimal access approach strategy is associated with a significant reduction in the cytokine response, as exemplified by reduced interleukin-6 levels and a corresponding reduction in acute-phase protein generation with reduced C-reactive protein levels. Circulating immune cell function and numbers also are better preserved. These changes have been demonstrated in comparing open with video-assisted thoracoscopic surgery (VATS) lobectomy and, together with further investigation into local immune function, may offer some insight into the excellent survival data reported for VATS resection of stage I non-small cell lung cancer.
Walker
William S
WS
Department of Thoracic Surgery, Royal Infirmary of Edinburgh, Little France, Edinburgh, EH16 4SA, Scotland, UK. wsw@holyrood.ed.ac.uk
Leaver
H Anne
HA
D002986:Clinical Trials as Topic; D016207:Cytokines / Q000378:metabolism; D006801:Humans; D007109:Immunity; D008175:Lung Neoplasms / Q000276:immunology* / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011013:Pneumonectomy / Q000009:adverse effects* / Q000379:methods; D013312:Stress, Physiological; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects*
D016207:Cytokines