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Innate immune responses after resection for lung cancer via video-assisted thoracoscopic surgery and thoracotomy

Lookup NU author(s): Professor John SimpsonORCiD


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Objective: 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. Methods: 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. Results: 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 > 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). Conclusions: Overall, a trend toward greater proinflammatory and anti-inflammatory responses is seen with lung resection performed via thoracotomy compared with VATS. Copyright © 2014 by the International Society for Minimally Invasive Cardiothoracic Surgery.

Publication metadata

Author(s): Jones RO, Anderson NH, Murchison JT, Brittan M, Simon EJ, Casali G, Simpson AJ, Walker WS

Publication type: Article

Publication status: Published

Journal: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

Year: 2014

Volume: 9

Issue: 2

Pages: 93-103

Print publication date: 01/03/2014

Acceptance date: 01/01/1900

ISSN (print): 1556-9845

ISSN (electronic): 1559-0879

Publisher: Lippincott Williams and Wilkins


DOI: 10.1097/IMI.0000000000000061


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