Background. Video-assisted thoracic surgery (VATS) lobectomy for early lung
cancer has been shown to be technically feasible. Comparative studies on l
aparoscopic versus open procedures indicate that laparoscopy may reduce inf
lammatory reactions as reflected by the lesser release of cytokines. We inv
estigated the cytokine responses following VATS and conventional lobectomy
for clinical stage I lung cancer.
Methods. Thirty-six patients with clinical stage I nonsmall cell lung cance
r were studied. 18 patients underwent VATS lobectomy and the other 18 by co
nventional thoracotomy. There were no differences between the two groups wi
th respect to age, gender, pulmonary function, smoking history, comorbidity
, tumor size, and pathology. Plasma levels of tumor necrosis factor-alpha (
TNF alpha), interleukin (IL)-1 beta, IL-6, IL-8, and an antiinflammatory cy
tokine IL-10 were measured before surgery, at the end of the procedure, and
4, 8, 24, and 48 hours thereafter in all patients.
Results. There was no mortality or major complication in either group. Anal
gesic requirement was significantly less in the VATS group. Although the re
lease of TNF-alpha and IL-1 beta were minimal after surgery in both groups,
the levels of IL-6, IL-8, and IL-10 were elevated. IL-6 and IL-8 levels we
re significantly lower in the VATS group at the end of surgery than in the
open group. In addition, reduced release of IL-10 was also observed in the
VATS group shortly after surgery.
Conclusions. VATS lobectomy is associated with reduced postoperative releas
e of both proinflammatory and antiinflammatory cytokines compared with the
open approach. The clinical significance of these findings remains to be fu
lly elucidated. (Ann Thorac Surg 2000;70:243-7) (C) 2000 by The Society of
Thoracic Surgeons.