Acute phase responses following minimal access and conventional thoracic surgery

Objectives: Major thoracic surgery is associated with trauma-related immuno logical changes. These may impair anti-tumour immunity. We hypothesize that the reduced operative trauma associated with a video-assisted thoracic sur gery (VATS) approach may decrease acute phase responses and, consequently, lead to better preservation of immune function. This prospective randomized study compared the effects of conventional open thoracic surgery and VATS on acute phase responses in patients undergoing pulmonary lobectomy. Method s: Acute phase indicators were analyzed in patients undergoing lobectomy fo r suspected bronchogenic carcinoma. Surgery was prospectively randomized to pulmonary lobectomy by VATS or limited postero-lateral thoracotomy. Blood was taken pre-operatively and at 4, 24, 48, 72, 120 and 168 h post-operativ ely for analysis of C-reactive protein (CRP; 41 patients: open, n = 22; VAT S, n = 19) interleukin (IL)-6, tumour necrosis factor (TNF) receptors (TNF- sR55, TNF-sR75) and P-selectin (24 patients: open, n = 12; VATS, n = 12). S amples taken at 48 and 168 h were also analyzed for phagocyte reactive oxyg en species (ROS) production (25 patients: open, n = 16; VATS, n = 19). Resu lts: Surgery increased acute phase responses. VATS was associated with lowe r CRP and IL-6 levels. In the open surgery group, significant increases in ROS in neutrophils (up to 36% greater than before surgery, n = 12, P < 0.02 -0.05) were detected at 2 days after surgery, but in the VATS group, the in crease after surgery (of up to 17%, n = 18) did not reach significance. Sim ilarly, monocyte ROS increases of up to 25% in the mean ROS in the open sur gery group and of up to 17% in the VATS group were detected on days 2 and 7 after surgery. Conclusions: VATS pulmonary lobectomy is associated with re duced peri-operative changes in acute phase responses. This finding may hav e implications for peri-operative tumour immuno-surveillance in lung cancer patients. (C) 2001 Elsevier Science B.V. All rights reserved.