Skip to main content
SpringerLink
Log in

Artificial pneumothorax suppresses postoperative inflammatory reaction in mediastinal tumor surgery

  • Original Article
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Objective

The induction of artificial pneumothorax has many intraoperative advantages. However, few reports on the postoperative effects of artificial pneumothorax induction are available. In this study, we investigated the effect of artificial pneumothorax on postoperative clinical course in patients with mediastinal tumors.

Methods

We retrospectively investigated the clinical courses of 89 patients who had undergone mediastinal tumor resection between January 2010 and December 2020. Sixty-five patients had undergone resection with artificial pneumothorax.

Results

The tumor location significantly varied across patients. The proportion of patients in whom artificial pneumothorax was induced was higher among those having anterior mediastinal tumors. The number of ports and the total skin incision length were significantly higher in patients without artificial pneumothorax. The C-reactive protein level elevation on postoperative day 2 and pleural effusion at 24 h after surgery were significantly higher in patients without artificial pneumothorax. Furthermore, the albumin level reduction and hospital stay after surgery were significantly lower in patients with artificial pneumothorax. Multiple regression analysis showed that the use of artificial pneumothorax was an independent predictive factor of the C-reactive protein level elevation on postoperative day 2 and pleural effusion at 24 h after surgery. In patients without artificial pneumothorax, the operation time positively correlated with the C-reactive protein level (r = 0.646, P < 0.001).

Conclusions

Artificial pneumothorax suppressed the postoperative inflammatory response, pleural effusion, and albumin reduction, and shortened the hospital stay in patients undergoing mediastinal tumor surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Nomura S, Tsujimoto H, Ishibashi Y, Fujishima S, Kouzu K, Harada M, et al. Efficacy of artificial pneumothorax under two-lung ventilation in video-assisted thoracoscopic surgery for esophageal cancer. Surgical Endosc. 2020;34:5501–7.

    Article  Google Scholar 

  2. Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position–experience of 130 patients. J Am Coll Surg. 2006;203:7–16.

    Article  Google Scholar 

  3. Zhao M, Jiang T, Li M, Yang X, Dai X, Shen Y, et al. Video-assisted thoracoscopic total thymectomy: two-lung ventilation with artificial pneumothorax. Minim Invasive Ther Allied Technol. 2020;29:380–4.

    Article  Google Scholar 

  4. Takemura M, Kaibe N, Takii M, Sasako M. Operative benefits of artificial pneumothorax in thoracoscopic esophagectomy in the left lateral decubitus position for esophageal cancer. Int J Clin Med. 2015;06:8.

    Article  Google Scholar 

  5. Hanly EJ, Mendoza-Sagaon M, Murata K, Hardacre JM, De Maio A, Talamini MA. CO2 Pneumoperitoneum modifies the inflammatory response to sepsis. Ann Surg. 2003;237:343–50.

    PubMed  PubMed Central  Google Scholar 

  6. Jatzko GR, Lisborg PH, Pertl AM, Stettner HM. Multivariate comparison of complications after laparoscopic cholecystectomy and open cholecystectomy. Ann Surg. 1995;221:381–6.

    Article  CAS  Google Scholar 

  7. Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP. Laparoscopic surgery and the systemic immune response. Ann Surg. 1998;227:326–34.

    Article  Google Scholar 

  8. Watson RW, Redmond HP, McCarthy J, Burke PE, Bouchier-Hayes D. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg. 1995;82:1060–5.

    Article  CAS  Google Scholar 

  9. Tsukioka T, Takemura S, Minamiyama Y, Nishiyama N, Mizuguchi S, Okada S, et al. Local and systemic impacts of pleural oxygen exposure in thoracotomy. BioFactors. 2007;30:117–28.

    Article  CAS  Google Scholar 

  10. Sancheti MS, Dewan BP, Pickens A, Fernandez FG, Miller DL, Force SD. Thoracoscopy without lung isolation utilizing single lumen endotracheal tube intubation and carbon dioxide insufflation. Ann Cardiothorac Surg. 2013;96:439–44.

    Google Scholar 

  11. Suda T, Ashikari S, Tochii S, Sugimura H, Hattori Y. Single-incision subxiphoid approach for bilateral metastasectomy. Ann Cardiothorac Surg. 2014;97:718–9.

    Google Scholar 

  12. Neumaier M, Scherer MA. C-reactive protein levels for early detection of postoperative infection after fracture surgery in 787 patients. Acta Orthop. 2008;79:428–32.

    Article  Google Scholar 

  13. Swanson SJ, Herndon JE 2nd, D’Amico TA, Demmy TL, McKenna RJ Jr, Green MR, et al. Video-assisted thoracic surgery lobectomy: report of CALGB 39802—a prospective, multi-institution feasibility study. J Clin Oncol. 2007;25:4993–7.

    Article  Google Scholar 

  14. Kanda Y. Investigation of the freely available easy-to-use software “EZR” for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  Google Scholar 

  15. Guyton AC, Hall JE. Transport of oxygen and carbon dioxide in the blood and body fluids. In: Guyton AC, Hall JE, editors. Textbook of medical physiology. 10th ed. Philadelphia: W.B. Saunders; 2000. p. 464–73.

    Google Scholar 

  16. Light RW, Macgregor MI, Luchsinger PC, Ball WC Jr. Pleural effusions: the diagnostic separation of transudates and exudates. Ann Intern Med. 1972;77:507–13.

    Article  CAS  Google Scholar 

  17. Lim S, Koh A. Nutrition and the elderly surgical patients. MOJ Surg. 2017;4:114–20.

    Google Scholar 

  18. Ye B, Tantai JC, Li W, Ge XX, Feng J, Cheng M, et al. Video-assisted thoracoscopic surgery versus robotic-assisted thoracoscopic surgery in the surgical treatment of Masaoka stage I thymoma. World J Surg Oncol. 2013;11:157.

    Article  Google Scholar 

  19. Şehitogullari A, Nasır A, Anbar R, Erdem K, Bilgin C. Comparison of perioperative outcomes of videothoracoscopy and robotic surgical techniques in thymoma. Asian J Surg. 2020;43:244–50.

    Article  Google Scholar 

  20. Haruki T, Kubouchi Y, Takagi Y, Kidokoro Y, Matsui S, Nakanishi A, et al. Comparison of medium-term survival outcomes between robot-assisted thoracoscopic surgery and video-assisted thoracoscopic surgery in treating primary lung cancer. Gen Thorac Cardiovasc Surg. 2020;68:984–92.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Thoracic Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Ryuichi Ito, Takuma Tsukioka, Nobuhiro Izumi, Hiroaki Komatsu, Hidetoshi Inoue, Takuya Kimura & Noritoshi Nishiyama

  2. Department of Cardiovascular Surgery, Osaka City University, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan

    Toshihiko Shibata

Authors
  1. Ryuichi Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takuma Tsukioka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nobuhiro Izumi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroaki Komatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hidetoshi Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Takuya Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshihiko Shibata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Noritoshi Nishiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takuma Tsukioka.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest to disclose.

Ethical approval

The local institutional ethics committee approved this study (approval no. 2020-247; approval date, January 7, 2021).

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ito, R., Tsukioka, T., Izumi, N. et al. Artificial pneumothorax suppresses postoperative inflammatory reaction in mediastinal tumor surgery. Gen Thorac Cardiovasc Surg 70, 257–264 (2022). https://doi.org/10.1007/s11748-021-01716-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-021-01716-z

Keywords

Search

Navigation