title: Surgical trauma and immune functional changes following major lung resection.
abstract: Video-assisted thoracic surgery (VATS) has evolved greatly over the last two decades. VATS major lung resection for early stage non-small cell lung carcinoma (NSCLC) has been shown to result in less postoperative pain, less pulmonary dysfunction postoperatively, shorter hospital stay, and better patient tolerance to adjuvant chemotherapy compared with patients who underwent thoracotomy. Several recent studies have even reported improved long-term survival in those who underwent VATS major lung resection for early stage NSCLC when compared with open technique. Interestingly, the immune status and autologous tumor killing ability of lung cancer patients have previously been associated with long-term survival. VATS major lung resection can result in an attenuated postoperative inflammatory response. Furthermore, the minimal invasive approach better preserve patients' postoperative immune function, leading to higher circulating natural killer and T cells numbers, T cell oxidative activity, and levels of immunochemokines such as insulin growth factor binding protein 3 following VATS compared with thoracotomy. Apart from host immunity, the angiogenic environment following surgery may also have a role in determining cancer recurrence and possibly survival. Whether differences in immunological and biochemical mediators contribute significantly towards improved clinical outcomes following VATS major lung resection for lung cancer remains to be further investigated. Future studies will also need to address whether the reduced access trauma from advanced thoracic surgical techniques, such as single-port VATS, can further attenuate the postoperative inflammatory response.
authors.affiliation: Division of Cardiothoracic Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T, Hong Kong, SAR China.
authors.forename: Calvin S H
authors.initials: CS
authors.lastname: Ng
authors.affiliation: Department of Cardiothoracic Surgery, St Bartholomew's Hospital, West Smithfield, London, UK.
authors.forename: Kelvin K W
authors.initials: KK
authors.lastname: Lau
keywords: Angiogenesis; Immune; Inflammation; Single port; Thoracotomy; Trauma; VATS
references.citation: Oncol Rep. 2004 Mar;11(3):673-6
references.pmid: 14767520
references.citation: Am J Surg. 2012 Nov;204(5):607-12
references.pmid: 22959921
references.citation: Cancer Immunol Immunother. 2008 Dec;57(12):1757-69
references.pmid: 18351336
references.citation: Surg Endosc. 2008 Feb;22(2):287-97
references.pmid: 18204877
references.citation: Am J Physiol Lung Cell Mol Physiol. 2005 Sep;289(3):L446-53
references.pmid: 15894558
references.citation: Clin Cancer Res. 1999 Jan;5(1):149-53
references.pmid: 9918213
references.citation: Ann Thorac Surg. 2000 Jul;70(1):243-7
references.pmid: 10921716
references.citation: Eur J Cardiothorac Surg. 2001 Sep;20(3):455-63
references.pmid: 11509263
references.citation: Lung Cancer. 2002 Aug;37(2):161-9
references.pmid: 12140139
references.citation: J Natl Cancer Inst. 1990 Nov 7;82(21):1697-701
references.pmid: 2231757
references.citation: J Thorac Cardiovasc Surg. 1978 Oct;76(4):479-82
references.pmid: 703354
references.citation: Cell Immunol. 1998 Mar 15;184(2):121-8
references.pmid: 9630838
references.citation: Ann Thorac Surg. 2007 Apr;83(4):1245-9; discussion 1250
references.pmid: 17383320
references.citation: Ann Thorac Surg. 2002 Aug;74(2):615-23
references.pmid: 12173869
references.citation: Anesth Analg. 2003 Sep;97(3):822-7
references.pmid: 12933409
references.citation: J Thorac Cardiovasc Surg. 2006 Sep;132(3):701-2
references.pmid: 16935138
references.citation: Ann Surg. 1998 Mar;227(3):326-34
references.pmid: 9527054
references.citation: Ann Thorac Surg. 2001 Aug;72(2):362-5
references.pmid: 11515867
references.citation: Thorax. 2013 Jul;68(7):681
references.pmid: 23462160
references.citation: Blood. 1994 Dec 15;84(12):4008-27
references.pmid: 7994020
references.citation: Ann Thorac Surg. 2006 Sep;82(3):1021-6
references.pmid: 16928528
references.citation: World J Surg. 2005 Aug;29(8):975-81
references.pmid: 15981046
references.citation: Clin Cancer Res. 2002 Dec;8(12):3796-802
references.pmid: 12473592
references.citation: J Invest Surg. 2005 Mar-Apr;18(2):81-8
references.pmid: 16036776
references.citation: Cancer. 1997 Feb 1;79(3):474-81
references.pmid: 9028357
references.citation: J Thorac Cardiovasc Surg. 2012 Mar;143(3):745-7
references.pmid: 21868042
references.citation: Surg Endosc. 2007 Apr;21(4):653-8
references.pmid: 17165116
references.citation: Lancet. 1993 Jan 2;341(8836):21-2
references.pmid: 8093269
references.citation: Surgery. 2004 Aug;136(2):205-9
references.pmid: 15300181
references.citation: Surg Today. 2009;39(8):682-8
references.pmid: 19639435
references.citation: Eur J Clin Invest. 2000 Mar;30(3):230-8
references.pmid: 10692000
references.citation: Am J Surg. 1999 Jan;177(1):55-60
references.pmid: 10037309
references.citation: Surgery. 1996 Mar;119(3):316-25
references.pmid: 8619187
references.citation: Dis Colon Rectum. 2001 May;44(5):638-46
references.pmid: 11357021
references.citation: Anticancer Res. 2005 May-Jun;25(3B):2027-31
references.pmid: 16158940
references.citation: Immunol Rev. 2004 Dec;202:96-105
references.pmid: 15546388
references.citation: Ann Thorac Surg. 2000 Nov;70(5):1644-6
references.pmid: 11093502
references.citation: J Thorac Cardiovasc Surg. 2000 May;119(5):899-905
references.pmid: 10788810
references.citation: Ann Surg. 2006 Nov;244(5):792-8
references.pmid: 17060773
references.citation: Eur J Cardiothorac Surg. 2007 Dec;32(6):868-72
references.pmid: 17923413
references.citation: Eur J Cardiothorac Surg. 2007 Jan;31(1):83-7
references.pmid: 17118669
references.citation: Eur J Cardiothorac Surg. 2010 Feb;37(2):451-5
references.pmid: 19747837
references.citation: ScientificWorldJournal. 2012;2012:636754
references.pmid: 23024612
references.citation: Ann Surg. 2000 Apr;231(4):506-11
references.pmid: 10749610
references.citation: Cancer Res. 2002 Feb 15;62(4):1030-5
references.pmid: 11861378
references.citation: J Surg Oncol. 2012 Sep 15;106(4):431-5
references.pmid: 22442010
references.citation: J Thorac Cardiovasc Surg. 2008 Mar;135(3):642-7
references.pmid: 18329487
references.citation: Nature. 1980 Mar 6;284(5751):67-8
references.pmid: 6243750
references.citation: Int J Cancer. 1980 Jan 15;25(1):9-17
references.pmid: 6447114
references.citation: J Thorac Cardiovasc Surg. 2006 Sep;132(3):507-12
references.pmid: 16935102
references.citation: Surg Endosc. 2007 Sep;21(9):1607-11
references.pmid: 17762957
references.citation: Chest. 1988 Oct;94(4):887-9
references.pmid: 3168591