Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients
- 268 Downloads
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.
KeywordsVideo-assisted thoracoscopic surgery Traditional open surgery Immune function Thoracoscope Lung cancer
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.
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 was obtained from all individual participants included in the study.
- 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
- 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.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.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
- 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.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.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
- 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.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.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.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.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