Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure

Nagahiro, Itaru; Andou, Akio; Aoe, Motoi; Sano, Yoshifumi; Date, Hiroshi; Shimizu, Nobuyoshi

doi:10.1016/s0003-4975(01)02804-1

Cited by 463 publications

(257 citation statements)

References 13 publications

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“…This might be due to relatively small scale of this registry study. On the other hand, VATS is a reliable approach for the treatment of lung cancer with low complication rate and has been well confirmed by other studies (17,18). Complete VATS was applied in 98.3% of patients in our study, which to some extent might be the reason for the low incidence rates of POP.…”

Section: Discussionsupporting

confidence: 56%

Identifying patients at higher risk of pneumonia after lung resection

et al. 2017

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Background: Pneumonia is considered as one of the most common and serious complications after lung resection. The purpose of this study was to identify the risk factors associated with postoperative pneumonia (POP) after lung resection and to develop a scoring system to stratify patients with increased risk of POP.Methods: A retrospective review of a prospective database of patients between September 2014 and June 2016 was carried out. Logistic regression analysis was used to examine the risk factors for POP. Bootstrap resampling analysis was used for internal validation. Regression coefficients were used to develop weighted risk scores for POP.Results: Results revealed that age ≥64 years, smoking (current or previous), high pathological stage, and extent of excision of more than one lobe as risk factors. Logistic regression analysis showed that the predictors of POP were as follows: age ≥64 years, smoking, extent of excision of more than one lobe.A weighted score based on these factors was developed which was follows: smoking (three points), age ≥64 years (four points), and extent of excision of more than one lobe (five points). POP score >5 points offered the best combination of sensitivity (64.7%) and specificity (83.3%), and an area under receiver operating characteristic (ROC) curve ( Conclusions: Patients with older age, smoking and extent of excision of more than one lobe have a higher risk for pneumonia after lung cancer surgery. Also, the scoring system helps to guide decision making of POP risk reduction.

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Section: Discussionsupporting

confidence: 56%

Identifying patients at higher risk of pneumonia after lung resection

et al. 2017

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“…This last aspect, we believe is an element to be taken into consideration and confirms the superiority of minimally invasive access for surgical treatment of lung cancer. Similar results were published by Nagahiro et al (4) in a trial of 22 NSCLC patients. In fact, serum IL-6 levels appeared significantly increased at POD 0 in the thoracotomy group when compared to the VATS one (21.6 vs. 4.1 pg/mL, P<0.03, respectively).…”

supporting

confidence: 90%

Immune response after video-assisted thoracic surgery in non-small cell lung cancer patients

2018

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The effects of immunomodulation processes in patients undergoing video-assisted thoracic surgery (VATS) lobectomy are still debated; although, the reduced surgical stress of minimally invasive surgery is evident. The immunological repercussions could also influence the evolution of the disease and the prognosis of patients. The article aims to raise some points of reflection by considering available evidences and reiterating, once again, the prognostic utility of a minimally invasive procedure rather than classical approach. Nagahiro et al. (4) in a trial of 22 NSCLC patients. In fact, serum IL-6 levels appeared significantly increased at POD 0 in the thoracotomy group when compared to the VATS one (21.6 vs. 4.1 pg/mL, P<0.03, respectively). In addition, both surgical and inflammatory stress present high mitogenic and apoptotic stimuli, whose dysregulation may result in a "skip effect" leading to hyperstimulation of cell membranes and the activation of uncontrolled cellular turnover processes. In this regard, Ng et al. (5), about a decade ago, hypothesized a fundamental role of some transcription of growth factors in the prognosis of patients with early stage NSCLC. Furthermore, by comparing VATS versus classical approaches, the Authors found significant differences in postoperative serum levels of insulin-like growth factor binding protein (IGFBP)-3, that, like the insulin growth factor (IGF)-1, promotes cell apoptosis. Moreover, surgical stress seemed to activate the synthesis of matrix metalloproteinase (MMP)-9 with chelating effects on insulin-like growth factors. Regarding IGFBP-3, its levels appeared significantly higher in the VATS group at POD 1; while the levels of MMP-9 were doubled in thoracotomy patients compared to those minimally invasively treated (1,311 vs. 628 ng/mL). Similar conclusions were reported by Zhang et al. (6) in the largest published randomized trial including 122 patients. In particular, in the VATS group, IGFBP-3, VEGF and IL-6 levels at each time point after surgery were dramatically lower than in the thoracotomy brace. It would seem, therefore, that a standard approach represents rather a risk for the persistence of a pro-inflammatory microenvironment with the production of growth factors, cytokines and soluble factors, whose consequences still require further investigation. In the view of a systemic disease, however, inflammation could significantly influence patients' prognosis, as a multiorgan macroenvironments, through systemic manifestations as the onset of cachexia (7), protidemic depletion, increased risk of postoperative complications. In conclusion, the choice of a minimally invasive strategy finds its concrete rational in the preservation of the homeostasis of the organism by minimizing the predictable effects of a standard thoracotomy. Keywords AcknowledgementsNone. Footnote Conflicts of Interest:The authors have no conflicts of interest to declare. Immune response after video-assisted thoracic surgery in nonsmall cell lung cancer patients. J Vis Surg 201...

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“…IL-6, along with its proinflammatory effects, is a sensitive and early marker of tissue damage, and its magnitude of elevation is directly related to the extent of surgical trauma (Nagahiro et al, 2001;Raeburn et al, 2002). Yim et al(2000) found that plasma IL-6 was elevated after conventional lobectomy for clinical early-stage lung cancer.…”

Section: Modulation Of Cytokine Production By Tramadolmentioning

confidence: 99%

Effect of tramadol on immune responses and nociceptive thresholds in a rat model of incisional pain

Liu

Zhu

Wang

et al. 2008

J. Zhejiang Univ. Sci. B

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Abstract:Objective: To evaluate the effects of tramadol on the proinflammatory responses in a rat model of incisional pain by investigating its effects on nociceptive thresholds and serum interleukin-6 (IL-6) and IL-2 levels. Methods: Forty-two male Sprague-Dawley (SD) rats scheduled for plantar incision were randomly divided into 7 groups (n=6 in each group). Rats in Group 1 receiving general anesthesia with no incision were served as control; At 30 min before skin incision, Groups 2~5 were given 5 ml normal saline or 1, 10, and 20 mg/kg tramadol, respectively, intraperitoneally (i.p.); Group 6 received 10 mg/kg tramadol after operation; Group 7 received 10 mg/kg tramadol before incision, followed by 200 μg/kg naloxone after operation. Mechanical allodynia was measured by electronic von Frey filament to evaluate the nociceptive thresholds 1 h before incision, and 1 h and 2 h after operation. Serum IL-6 and IL-2 levels were measured by enzyme-linked immunosorbent assay (ELISA) 2 h after operation. Results: Mechanical thresholds decreased significantly and serum IL-6 level increased significantly after operation in Group 2 compared with control (P<0.01), and these changes were reversed respectively by tramadol in a dose-dependent manner (P<0.05 and P<0.01, respectively). IL-2 level remained unchanged after operation in Group 2, but decreased in Group 3 (P<0.05), then gradually returned to the normal level in Groups 4 and 5. The intraperitoneally injected tramadol (10 and 20 mg/kg) produced a potent and dose-dependent antinocicptive effect on the lesioned paw. The antinocicptive effects of tramadol were partially antagonized by naloxone (200 μg/kg), suggesting an additional non-opioid mechanism. Conclusion: The results suggest that tramadol could be a good choice for the treatment of pain under the conditions that immunosuppression may be particularly contraindicated.

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Pulmonary function, postoperative pain, and serum cytokine level after lobectomy: a comparison of VATS and conventional procedure

Cited by 463 publications

References 13 publications

Identifying patients at higher risk of pneumonia after lung resection

Identifying patients at higher risk of pneumonia after lung resection

Immune response after video-assisted thoracic surgery in non-small cell lung cancer patients

Effect of tramadol on immune responses and nociceptive thresholds in a rat model of incisional pain

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