[Cytokine responses after lobectomy: a prospective randomized comparison of video-assisted thoracoscopic surgery and minimal incision thoracotomy].

BACKGROUND & OBJECTIVE: The cytokine network plays a pivotal role in inducing acute-phase inflammatory and immunologic responses to surgical trauma. Whether lesser release of cytokines by mini-invasive operation can reduce acute-phase responses and better preserve immune functions needs to be explored. This prospective randomized study was to compare the effects of video-assisted thoracoscopic surgery (VATS) and minimal incision thoracotomy (MIT) on serum levels of cytokines after lobectomy for clinical early stage non-small cell lung cancer (NSCLC).

METHODS

From Mar. 2004 to Dec. 2006, 47 consecutive patients with early stage NSCLC (tumor size was <or=6 cm as showed on CT scan) were recruited and randomized into VATS group (n=24) and MIT group (n=23). Two patients in VATS group were excluded for conversion to posterolateral thoracotomy because of uncontrolled bleeding and dense pleural adhesion; 1 in MIT group was excluded for intraoperative blood transfusion. Serum levels of tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-2, IL-4, IL-6, and IL-10 were measured by cytometric bead array (CBA) before operation and at 4, 24, and 48 h after operation.

RESULTS

The serum levels of TNF-alpha, IL-2 and IL-4 were low after operation in both groups, and there were no significant differences between the 2 groups. Both IL-6 and IL-10 reached peak serum concentration (C max) at 4 h after operation: the C max of IL-6 was (91.0+/-63.9) ng/L in VATS group and (84.2+/-53.1) ng/L in MIT group (P=0.732)û the C max of IL-10 was (12.6+/-8.1) ng/L in VATS group and (16.3+/-11.2) ng/L in MIT group (P=0.235). The changes in serum concentration of IL-6 and IL-10 in the 2 groups among the 4 time points were not significant (F=0.143, P=0.708 for IL-6; F=0.000, P=0.996 for IL-10).

CONCLUSIONS

Compared with MIT, VATS major lung resection can't reduce postoperative release of cytokines. The clinical significance of these findings remains to be fully elucidated.