Surgical Trauma and Immune Functional Changes Following Major Lung Resection

Abstract

Video-assisted thoracic surgery (VATS) has evolved greatly over the last two decades. VATS major lung resection for early stage non-small cell lung carcinoma (NSCLC) has been shown to result in less postoperative pain, less pulmonary dysfunction postoperatively, shorter hospital stay, and better patient tolerance to adjuvant chemotherapy compared with patients who underwent thoracotomy. Several recent studies have even reported improved long-term survival in those who underwent VATS major lung resection for early stage NSCLC when compared with open technique. Interestingly, the immune status and autologous tumor killing ability of lung cancer patients have previously been associated with long-term survival. VATS major lung resection can result in an attenuated postoperative inflammatory response. Furthermore, the minimal invasive approach better preserve patients' postoperative immune function, leading to higher circulating natural killer and T cells numbers, T cell oxidative activity, and levels of immunochemokines such as insulin growth factor binding protein 3 following VATS compared with thoracotomy. Apart from host immunity, the angiogenic environment following surgery may also have a role in determining cancer recurrence and possibly survival. Whether differences in immunological and biochemical mediators contribute significantly towards improved clinical outcomes following VATS major lung resection for lung cancer remains to be further investigated. Future studies will also need to address whether the reduced access trauma from advanced thoracic surgical techniques, such as single-port VATS, can further attenuate the postoperative inflammatory response.

Dysfunctional Natural Killer Cells in the Aftermath of Cancer Surgery

“…NK cells were found to be lower post-operatively along with T cells and NKT cells and this effect was more pronounced in patients undergoing major surgery versus minor surgeries. Similarly, in non-small cell lung cancer patients NK cells were found to be significantly lower in patients undergoing open thoracotomy (major) versus video-assisted thoracoscopic lobectomy (minor) [ 89 ].…”

Analysis of the effect of video-assisted thoracoscopic surgery on immune function and survival in patients with early stage lung cancer undergoing radical operation

“…Swanson [13] and others have found that video-assisted thoracoscopic surgery can achieve the objective of The study found [14][15] that surgical trauma could inhibit somatic cell immunity and humoral immunity. degree of trauma [16][17] .…”

Definition of an advanced lung cancer and associated survival after video-assisted thoracoscopic surgery resection

“…Theoretically, VATS approach for LC may allow for a better preservation of the patient's immunity and optimize long-term survival (48). The potential advantages of minimally invasive major pulmonary resection may be explained by various mechanisms.…”

“…The association between a better preserved immune status following minimal invasive VATS resection for early stage NSCLC and improved survival remains a fantasy for the skeptics, as emphasized by C. Ng and K. Lau (48). In order to demonstrate such a relationship, authors suggested a large randomized trial that measures a comprehensive range of postoperative immune markers and a long-term survival following VATS and open lobectomy.…”