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Subcostal Specimen Removal in Completely Portal Robotic Lobectomy

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Early postoperative inflammatory response by procedure types: stapler-based segmentectomy versus lobectomy.

Yuya Ishikawa¹, Fumitsugu Kojima², Taisuke Ishii³

¹Department of Thoracic Surgery, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.

General Thoracic and Cardiovascular Surgery

|September 28, 2019

Summary

Thoracoscopic segmentectomy in lung cancer surgery leads to a higher acute inflammatory response (measured by C-reactive protein) compared to lobectomy, despite a favorable perioperative outcome. This suggests localized surgical stress may be a key factor.

Keywords:

C-reactive protein Inflammatory response Lobectomy Lung cancer Segmentectomy

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Area of Science:

Thoracic Surgery
Surgical Oncology
Inflammation Biomarkers

Background:

Perioperative C-reactive protein (CRP) levels are debated in lung cancer surgery outcomes.
The impact of specific surgical procedures, like segmentectomy versus lobectomy, on CRP levels requires clarification.

Purpose of the Study:

To compare postoperative C-reactive protein (CRP) levels between thoracoscopic segmentectomy and lobectomy for lung cancer.
To identify factors associated with elevated CRP levels after anatomical lung resection.

Main Methods:

Retrospective analysis of 186 patients undergoing anatomical lung resection (2014-2017).
Measurement of C-reactive protein (CRP) on postoperative days 1, 3, and 5.
Calculation of CRP change (ΔCRP) and regression analysis to identify associated factors.

Main Results:

Segmentectomy group showed significantly higher ΔCRP values than the lobectomy group.
Segmentectomy had shorter operation time, less blood loss, and shorter drainage periods.
Procedure type and smoking history were associated with higher ΔCRP; smoking history did not differ between groups.

Conclusions:

Thoracoscopic segmentectomy is linked to increased acute inflammatory response compared to lobectomy, despite better perioperative outcomes.
Localized surgical stress and damage to remaining lung segments may drive this inflammatory response.
Further research is needed to understand the mechanisms behind increased CRP in segmentectomy.