Uniportal Video Assisted Thoracic Surgery For Major Lung Resection Is Associated With Less Immunochemokine Disturbances
SZE YUEN PETER YU1, WING HUNG RAINBOW LAU1, YUK PUI INNES WAN1, MALCOLM JOHN UNDERWOOD1, GONG GEORGE CHEN2, SZE HANG CALVIN NG1.
1Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong, 2Surgical Research Laboratory, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
Background: Conventional multiportal video-assisted thoracic surgery (VATS) for major lung resection is known to cause less immunochemokine production compared to the thoracotomy approach. Whether uniportal VATS is similarly associated with lower early postoperative circulating levels of immunochemokines compared to multiportal VATS have not been studied.
Methods: All patients who received uniportal or multiportal VATS major lung resection were recruited for study. Patients with long-term corticosteroid or immunosuppressant use, dense pleural adhesions, complete pleural symphysis, conversion to open thoracotomy or required controlled rib fractures were excluded. Blood samples were collected preoperatively and postoperatively on days 1 and 3 for enzyme linked immunosorbent assay determination of serum levels of Tissue Inhibitor of Metalloproteinase (TIMP)-1, Insulin Growth Factor Binding Protein (IGFBP)-3, and Matrix Metalloproteinase (MMP)-9.
Results: From March 2014 to April 2017, 68 consecutive patients consented for the prospective study and received major lung resection by either uniportal VATS (N = 29) or multiportal VATS (N = 39) were identified. There were no clinically significant demographic differences between the two groups. There was no perioperative mortality. Uniportal VATS major lung resection was associated with lower post-operative levels of TIMP-1 (Day 1: 136.5 ± 30.1 vs. 183.0 ± 49.7 ng/ml, p<0.001; Day 3: 143.6 ± 29.7 vs. 172.5 ± 41.3 ng/ml, p = 0.010) and MMP-9 (Day 1: 1467.0 ± 715.3 vs. 2156.5 ± 1417.0 ng/ml, p=0.012; Day 3: 1099.5 ± 805.0 vs. 1549.1 ± 784.2 ng/ml, p = 0.053) compared to multiportal VATS. No differences were found for the level of IGFBP3. Subgroup analysis for stage I primary lung carcinoma revealed higher levels of MMP-9, and higher level of IGFBP-3 on post-operative day 3 associated with patients with recurrent disease.
Conclusion: Uniportal VATS major lung resection is associated with lower post-operative circulating levels of TIMP-1 and MMP-9, compared to the multiportal VATS approach. The clinical relevance of these postoperative changes on tumor biology following lung resection for cancer warrants further investigation.
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