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Medical Oncology

, 32:204 | Cite as

Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients

  • Lian-Bin ZhangEmail author
  • Bo Wang
  • Xu-Yi Wang
  • Liang ZhangEmail author
Original Paper

Abstract

In this study, we compared the effects of video-assisted thoracic surgery (VATS) and traditional open surgery (TOS) on immune system functioning in non-small cell lung cancer (NSCLC) patients. We enrolled 122 NSCLC patients in this study. The patients were randomly divided into VATS group (n = 61) and TOS group (n = 61). Plasma DNA concentration was analyzed by fluorescence quantitative PCR. Automatic blood analyzer was used to measure WBC-C, and immune nephelometry was employed to assess hs-CRP concentrations. The number of CD3+T, CD4+T and CD8+T lymphocytes in peripheral blood was estimated by flow cytometry. ELISA was used to quantify the levels of IGFBP-3, VEGF and IL-6. Compared to the TOS group, surgery-related blood loss and pain score on day 1 after surgery were lower in VATS group. After surgery, the out-of-bed activity occurred earlier and in-hospital stays were shorter in the VATS group compared to the TOS group. Plasma free DNA concentration of VATS group patients at first, third and fifth days after surgery was lower than that of the TOS group. WBC-C and hs-CRP levels were lower in the VATS group at each time point after surgery. The number of CD3+T, CD4+T, CD8+T lymphocytes and CD4+/CD8+ was lower in the TOS group compared to VATS group. Plasma IGFBP-3, VEGF and IL-6 levels were significantly lower in VATS group compared to the TOS group. Finally, incidence of complications in the VATS group was dramatically lower than the TOS group (all P < 0.05). Based on our findings, compared to TOS, VATS significantly decreased the incidence of acute-phase reaction and lowered the inhibition of immune functions after surgery.

Keywords

Video-assisted thoracoscopic surgery Traditional open surgery Immune function Thoracoscope Lung cancer 

Notes

Acknowledgments

We would like to acknowledge the reviewers for their helpful comments on this paper.

Conflict of interest

There was no conflict of interest existing in this paper.

Ethical standard

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Zhou C, Wu YL, Chen G, Feng J, Liu XQ, Wang C, et al. Erlotinib versus chemotherapy as first-line treatment for patients with advanced EGFR mutation-positive non-small-cell lung cancer (OPTIMAL, CTONG-0802): a multicentre, open-label, randomised, phase 3 study. Lancet Oncol. 2011;12(8):735–42. doi: 10.1016/S1470-2045(11)70184-X.PubMedCrossRefGoogle Scholar
  2. 2.
    Ishihara M, Igawa S, Maki S, Harada S, Kusuhara S, Niwa H, et al. Successful chemotherapy with nab-Paclitaxel in a heavily treated non-small cell lung cancer patient: a case report. Case Rep Oncol. 2014;7(2):401–6. doi: 10.1159/000364857.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Chen P, Wang L, Liu B, Zhang HZ, Liu HC, Zou Z. EGFR-targeted therapies combined with chemotherapy for treating advanced non-small-cell lung cancer: a meta-analysis. Eur J Clin Pharmacol. 2011;67(3):235–43. doi: 10.1007/s00228-010-0965-4.PubMedCrossRefGoogle Scholar
  4. 4.
    Kazandjian D, Blumenthal GM, Chen HY, He K, Patel M, Justice R, et al. FDA approval summary: crizotinib for the treatment of metastatic non-small cell lung cancer with anaplastic lymphoma kinase rearrangements. Oncologist. 2014;19(10):e5–11. doi: 10.1634/theoncologist.2014-0241.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Higuchi M, Yaginuma H, Yonechi A, Kanno R, Ohishi A, Suzuki H, et al. Long-term outcomes after video-assisted thoracic surgery (VATS) lobectomy versus lobectomy via open thoracotomy for clinical stage IA non-small cell lung cancer. J Cardiothorac Surg. 2014;. doi: 10.1186/1749-8090-9-88.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Yan TD, Black D, Bannon PG, McCaughan BC. Systematic review and meta-analysis of randomized and nonrandomized trials on safety and efficacy of video-assisted thoracic surgery lobectomy for early-stage non-small-cell lung cancer. J Clin Oncol. 2009;27(15):2553–62. doi: 10.1200/JCO.2008.18.2733.PubMedCrossRefGoogle Scholar
  7. 7.
    Jiang G, Yang F, Li X, Liu J, Li J, Zhao H, et al. Video-assisted thoracoscopic surgery is more favorable than thoracotomy for administration of adjuvant chemotherapy after lobectomy for non-small cell lung cancer. World J Surg Oncol. 2011. doi: 10.1186/1477-7819-9-170.Google Scholar
  8. 8.
    Yamashita S, Chujo M, Kawano Y, Miyawaki M, Tokuishi K, Anami K, et al. Clinical impact of segmentectomy compared with lobectomy under complete video-assisted thoracic surgery in the treatment of stage I non-small cell lung cancer. J Surg Res. 2011;166(1):46–51. doi: 10.1016/j.jss.2009.04.006.PubMedCrossRefGoogle Scholar
  9. 9.
    Verstegen NE, Oosterhuis JW, Palma DA, Rodrigues G, Lagerwaard FJ, van der Elst A, et al. Stage I-II non-small-cell lung cancer treated using either stereotactic ablative radiotherapy (SABR) or lobectomy by video-assisted thoracoscopic surgery (VATS): outcomes of a propensity score-matched analysis. Ann Oncol. 2013;24(6):1543–8. doi: 10.1093/annonc/mdt026.PubMedCrossRefGoogle Scholar
  10. 10.
    Scott WJ, Allen MS, Darling G, Meyers B, Decker PA, Putnam JB, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;139(4):976–81. doi: 10.1016/j.jtcvs.2009.11.059 (discussion 81-3).PubMedCrossRefGoogle Scholar
  11. 11.
    Park BJ. Robotic lobectomy for non-small cell lung cancer (NSCLC): multi-center registry study of long-term oncologic results. Ann Cardiothorac Surg. 2012;1(1):24–6. doi: 10.3978/j.issn.2225-319X.2012.04.09.PubMedCentralPubMedGoogle Scholar
  12. 12.
    Kim HK, Choi YS, Kim J, Shim YM, Kim K. Outcomes of unexpected pathologic N1 and N2 disease after video-assisted thoracic surgery lobectomy for clinical stage I non-small cell lung cancer. J Thorac Cardiovasc Surg. 2010;140(6):1288–93. doi: 10.1016/j.jtcvs.2010.06.011.PubMedCrossRefGoogle Scholar
  13. 13.
    Whitson BA, Groth SS, Duval SJ, Swanson SJ, Maddaus MA. Surgery for early-stage non-small cell lung cancer: a systematic review of the video-assisted thoracoscopic surgery versus thoracotomy approaches to lobectomy. Ann Thorac Surg. 2008;86(6):2008–16. doi: 10.1016/j.athoracsur.2008.07.009 (discussion 16-8).PubMedCrossRefGoogle Scholar
  14. 14.
    Tian W, Tong H, Sun Y, Li X, Wu Q, Ma C, et al. Comparison of the changes of thyroid hormones after video-assisted thoracoscopic surgery and conventional thoracotomy in patients with non-small cell lung cancer. Zhongguo Fei Ai Za Zhi. 2013;16(12):651–5. doi: 10.3779/j.issn.1009-3419.2013.12.06.PubMedGoogle Scholar
  15. 15.
    Oldenmenger WH, de Raaf PJ, de Klerk C, van der Rijt CC. Cut points on 0–10 numeric rating scales for symptoms included in the Edmonton Symptom Assessment Scale in cancer patients: a systematic review. J Pain Symptom Manag. 2013;45(6):1083–93. doi: 10.1016/j.jpainsymman.2012.06.007.CrossRefGoogle Scholar
  16. 16.
    Palma D, Visser O, Lagerwaard FJ, Belderbos J, Slotman BJ, Senan S. Impact of introducing stereotactic lung radiotherapy for elderly patients with stage I non-small-cell lung cancer: a population-based time-trend analysis. J Clin Oncol. 2010;28(35):5153–9. doi: 10.1200/JCO.2010.30.0731.PubMedCrossRefGoogle Scholar
  17. 17.
    Park JS, Kim K, Choi MS, Chang SW, Han WS. Video-assisted thoracic surgery (VATS) lobectomy for pathologic stage I non-small cell lung cancer: a comparative study with thoracotomy lobectomy. Korean J Thorac Cardiovasc Surg. 2011;44(1):32–8. doi: 10.5090/kjtcs.2011.44.1.32.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Ito Y, Oda M, Tsunezuka Y, Matsumoto I, Ishikawa N, Kawakami K, et al. Reduced perioperative immune response in video-assisted versus open surgery in a rat model. Surg Today. 2009;39(8):682–8. doi: 10.1007/s00595-008-3935-z.PubMedCrossRefGoogle Scholar
  19. 19.
    Ng CS, Wan IY, Yim AP. Impact of video-assisted thoracoscopic major lung resection on immune function. Asian Cardiovasc Thorac Ann. 2009;17(4):426–32. doi: 10.1177/0218492309338100.PubMedCrossRefGoogle Scholar
  20. 20.
    Vanni G, Tacconi F, Sellitri F, Ambrogi V, Mineo TC, Pompeo E. Impact of awake videothoracoscopic surgery on postoperative lymphocyte responses. Ann Thorac Surg. 2010;90(3):973–8. doi: 10.1016/j.athoracsur.2010.04.070.PubMedCrossRefGoogle Scholar
  21. 21.
    Rueth NM, Andrade RS. Is VATS lobectomy better: perioperatively, biologically and oncologically? Ann Thorac Surg. 2010;89(6):S2107–11. doi: 10.1016/j.athoracsur.2010.03.020.PubMedCrossRefGoogle Scholar
  22. 22.
    Li Z, Liu H, Li L. Video-assisted thoracoscopic surgery versus open lobectomy for stage I lung cancer: a meta-analysis of long-term outcomes. Exp Ther Med. 2012;3(5):886–92. doi: 10.3892/etm.2012.485.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of Thoracic SurgeryChinese PLA General HospitalBeijingPeople’s Republic of China
  2. 2.The Thoracic Department of Liaoning Cancer Hospital and InstituteShenyangPeople’s Republic of China

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