Acute phase responses following minimal access and conventional thoracic surgery

Area of Science:

• Immunology
• Thoracic Surgery
• Oncology

Background:

• Major thoracic surgery can trigger trauma-related immunological changes that may compromise anti-tumour immunity.
• Minimally invasive approaches like VATS may reduce surgical trauma and preserve immune function.

Purpose of the Study:

• To compare the effects of conventional open thoracic surgery versus VATS on acute phase responses in patients undergoing pulmonary lobectomy.
• To investigate if VATS preserves immune function better than open surgery by reducing acute phase responses.

Main Methods:

• Prospective randomized study comparing VATS and open thoracotomy for pulmonary lobectomy.
• Analysis of acute phase indicators including C-reactive protein (CRP), interleukin-6 (IL-6), TNF receptors, P-selectin, and reactive oxygen species (ROS) production in neutrophils and monocytes.
• Blood samples collected pre-operatively and at multiple time points up to 168 hours post-operatively.

Main Results:

• Both surgical approaches increased acute phase responses, but VATS was associated with significantly lower CRP and IL-6 levels.
• Open surgery led to significant increases in neutrophil ROS production post-operatively, while VATS did not show a significant increase.
• Monocyte ROS production also showed a trend towards lower increases in the VATS group compared to the open surgery group.

Conclusions:

• VATS pulmonary lobectomy is associated with attenuated peri-operative acute phase responses compared to open surgery.
• These findings suggest VATS may offer better preservation of immune function, potentially impacting peri-operative immuno-surveillance in lung cancer patients.