Systemic inflammatory response and complications developing in patients undergoing lobectomy for non-small-cell lung...

The present study investigates the effect of different surgical approaches on the systemic inflammatory response and the development of complications in patients undergoing lobectomy for non-small-cell lung cancer.

The data of 223 patients who underwent lobectomy for non-small-cell lung cancer via either thoracotomy or video-assisted thoracoscopic surgery (VATS) between 2015 and 2023 were analyzed retrospectively. Neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV) were used to assess inflammatory response.

Of the patients included in the study, 39 (17.5%) were female and 184 (82.5%) were male, and mean age was 63.46 (standard deviation (SD) 10.24) years (min 18-max 84). Of the sample, 59 (26.5%) underwent lobectomy via VATS and 164 (73.5%) via thoracotomy. Delta NLR, delta SII, and delta PIV were all found to be higher in the thoracotomy group than in the VATS group (p < 0.001, p < 0.001, p = 0.002, respectively). In a univariate analysis examining development of complications, delta NLR and delta SII were significantly higher in the group with complications (p = 0.020, p = 0.026, respectively), while no significant difference was observed in delta PIV (p = 0.066). In multivariable linear regression models adjusted for age, gender, presence of comorbidity, tumor location, tumor size, lymph node involvement, tumor stage, and surgical method, thoracotomy was associated with a greater increase in delta NLR (p = 0.016), as well as approximately 71% and 84% greater increases in delta SII and delta PIV, respectively (p = 0.013 and p = 0.003).

The present study revealed that patients who underwent lobectomy via VATS for non-small-cell lung cancer had a lower systemic inflammatory response than those undergoing lobectomy via thoracotomy. The increase in inflammatory markers, including NLR, SII, and PIV, was more remarkable in patients undergoing thoracotomy.