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Innate Immune Responses After Resection for Lung Cancer via Video-Assisted Thoracoscopic Surgery and Thoracotomy

Jones, Richard O. MD*†; Anderson, Niall H. PhD; Murchison, John T. FRCR§; Brittan, Mairi PhD*; Simon, Ellis J. FRCA; Casali, Gianluca FRCS; Simpson, A. John MD, PhD; Walker, William S. FRCS

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: March/April 2014 - Volume 9 - Issue 2 - p 93–103
doi: 10.1097/IMI.0000000000000061
Original Articles

Objective Innate immune responses to pulmonary resection may be critical in the pathogenesis of important postoperative pulmonary complications and potentially longer-term survival. We sought to compare innate immunity of patients undergoing major pulmonary resection for bronchogenic carcinoma via video-assisted thoracoscopic surgery (VATS) and thoracotomy.

Methods Bronchoalveolar lavage was conducted in the contralateral lung before staging bronchoscopy and mediastinoscopy and immediately after lung resection. Blood and exhaled nitric oxide were sampled preoperatively and at 6, 24, and 48 hours postoperatively.

Results Forty patients were included (26 VATS and 14 thoracotomy). There was a lower systemic cytokine response from lung resection undertaken by VATS compared with thoracotomy [interleukin 6 (IL-6), analysis of variance (ANOVA) P = 0.026; IL-8, ANOVA P = 0.018; and IL-10, ANOVA P = 0.047]. The VATS patients had higher perioperative serum albumin levels (ANOVA P = 0.001). Lower levels of IL-10 were produced by lipopolysaccharide-stimulated blood monocytes from the VATS patients compared with the thoracotomy patients at 6 hours postoperatively (geometric mean ratio, 1.16; 95% confidence interval, 1.08–1.33; P = 0.011). No statistically significant differences in the neutrophil phagocytic capacity, overall leukocyte count, or differential leukocyte count were found between the surgical groups (ANOVA P > 0.05). No statistically significant differences in bronchoalveolar lavage fluid parameters were found. Exhaled nitric oxide levels fell postoperatively, which reached statistical significance at 48 hours (geometric mean ratio, 1.2; 95% confidence interval, 1.02–1.46; P = 0.029). There were no significant differences found between the surgical groups (ANOVA P = 0.331).

Conclusions Overall, a trend toward greater proinflammatory and anti-inflammatory responses is seen with lung resection performed via thoracotomy compared with VATS.

From *The University of Edinburgh, Medical Research Council Centre for Inflammation Research, The Queen’s Medical Research Institute, Edinburgh, UK; †Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK; ‡Centre for Population Health Sciences, The University of Edinburgh, Medical School, Edinburgh, UK; §Department of Radiology, and ∥Department of Anaesthesia, The Royal Infirmary of Edinburgh, Edinburgh, UK; and ¶Institute of Cellular Medicine, Medical School, Newcastle University, Newcastle-upon-Tyne, UK.

Accepted for publication January 12, 2014.

A. John Simpson, MD, PhD, and William S. Walker, FRCS, contributed equally to this study as senior authors.

Supported by a Scottish Chief Scientist Office research grant (CZB/4/604) and by the Sir Jules Thorn Charitable Trust for A. John Simpson, MD, PhD. Charitable funds were also obtained from the Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, Edinburgh, UK, for A. John Simpson, MD, PhD.

Disclosures: Gianluca Casali, FRCS, serves on the European VATS Advisory Board of Covidien, Dublin, Ireland. William S. Walker, FRCS, serves on the speaker’s bureau of Covidien, Dublin, Ireland. Richard O. Jones, MD; Niall H. Anderson, PhD; John T. Murchison, FRCR; Mairi Brittan, PhD; Ellis J. Simon, FRCA; and A. John Simpson, MD, PhD, declare no conflicts of interest.

Address correspondence and reprint requests to Richard O. Jones, MD, Department of Thoracic Surgery, The Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Rd, Edinburgh, EH16 4SA, UK. E-mail:

©2014 by the International Society for Minimally Invasive Cardiothoracic Surgery