VATS lobectomy reduces cytokine responses compared with conventional surgery

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.