Surgical wound-site inflammation: video-assisted thoracic surgery versus thoracotomy

Menna, Cecilia; Falco, Elena De; Teodonio, Leonardo; Andreetti, Claudio; Maurizi, Giulio; Ciccone, Anna Maria; D’Andrilli, Antonio; Cassiano, Francesco; Vanni, Camilla; Baccarini, A.; Rendina, Erino Angelo; Ibrahim, Mohsen

doi:10.1093/icvts/ivy231

Cited by 15 publications

(13 citation statements)

References 23 publications

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“…Another 17 papers were reviewed in full text. Finally, a total of 10 eligible studies [16–25] with 1514 patients were included in this meta-analysis after fully evaluation. Although slight differences exist in VATS and MST among institutions.…”

Section: Resultsmentioning

confidence: 99%

“…Eight studies [17–22, 24, 25] focused on postoperative complications assessing the safety of surgeries. A total of 86 patients in VATS group and 153 patients in MST group had postoperative complications.…”

Section: Resultsmentioning

confidence: 99%

“…A meta-analysis of 9 studies [16–22, 24, 25] with 1421 patients showed an obvious shortened length of hospital stay [MD: -1.50, 95%CI (− 2.28, − 0.73), P = 0.0001] following the VATS. Similarly, the shorten duration of chest tube drainage [MD: -0.71, 95%CI (− 1.18, − 0.24), P = 0.003] in VATS group was found in 6 studies [16] , [18–20, 22, 24] with 845 patients enrolled.…”

Section: Resultsmentioning

confidence: 99%

“…Another important merit of VATS is that it is even more beneficial those with limited pulmonary function, which make itself more adaptive to the treatment of lung cancer with chronic obstructive pulmonary disease patients [32, 33]. A recent study discussed the inflammation differences between the two group (VATS and MST) and a reduced inflammation was found during minimal invasive surgery both locally and systematically [34]. In contrast to common view, VATS represents higher cost, many studies have reported a reduction of medical cost with VATS approach [35, 36], probably because of shortening the length of hospital stay and reducing healthcare resources utilization.…”

Section: Discussionmentioning

confidence: 99%

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Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

Wang¹,

Pang²,

Tang³

et al. 2019

BMC Surg

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Background It has been widely accepted that video-assisted thoracoscopic surgery (VATS) lobectomy is superior to conventional open thoracotomy lobectomy in many aspects. However, the direct comparison between VATS and Muscle-sparing thoracotomy (MST) has not been widely conducted. We aimed to compare the perioperative outcomes in non-small cell lung cancer (NSCLC) patients following VATS and MST. Methods PubMed, EMBASE, the Cochrane Library and Web of Science were searched for relevant studies. The retrieval time was up to April 24, 2019. Studies investigating the comparison of video-assisted thoracoscopy and muscle-sparing thoracotomy were included in our meta-analysis. Odds ratio and mean differences with 95% confidential interval were applied to determine the effectiveness of dichotomous or continuous variables respectively. Results A total of 10 studies were included with 1514 patients. Compared with MST, the incidence of postoperative complications in VATS [OR = 0.54; 95%CI(0.4, 0.73); P < 0.001] and the hospital stay [MD = -1.5; 95%CI(− 2.28, − 0.73); P = 0.0001] decreased significantly, chest tube drainage time [MD = -0.71; 95%CI(− 1.18, − 0.24); P = 0.003] were shorter and the intraoperative blood loss [MD = − 43.87; 95%CI(− 73.66, − 14.08); P = 0.004] were less in VATS group. VATS also showed a relatively longer operative time [MD = 17.11; 95%CI(2.38, 31.85); P = 0.02]. However, no significant differences were observed in numbers of resected lymph nodes, postoperative mortality, postoperative pneumonia and postoperative bleeding. Conclusion Compared with MST, VATS was associated with lower incidence of postoperative complications, shorter length of hospital stay, less intraoperative blood loss and less chest tube drainage, which showed that VATS was a comparable method to MST. Meanwhile, these results should be further conformed by more randomized control trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

Wang¹,

Pang²,

Tang³

et al. 2019

BMC Surg

View full text Add to dashboard Cite

show abstract

“…45 There were no differences in IL-6 concentrations between the two groups, which may be due to the slower IL-6 response following inflammation. 46 Limitations of the study: Firstly, a previous study showed that sevoflurane could directly inhibit hypoxic pulmonary vasoconstriction, which may affect our results. 47 Secondly, some postoperative discomfort comes from chest tuberelated pain that is not sufficiently blocked by PVB.…”

Section: Pain At Restmentioning

confidence: 92%

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Yang¹,

Hao²,

Li³

et al. 2020

JPR

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Background: Although video-assisted thoracoscopic surgery (VATS) is increasingly used, the optimal analgesia strategy is still unknown. We explore the efficacy and safety of preemptive ultrasound-guided paravertebral block (PVB) combined with parecoxib during VATS. Methods: Seventy-four patients were divided into two groups. PVBs were performed before anesthesia induction under real-time ultrasound guidance. Visual analog scale (VAS) score with coughing at 48 h after surgery, postoperative sufentanil consumption and level of sedation (LOS) at 1, 4, 8, 12, 24, and 48 h postoperatively, intraoperative hemodynamics, satisfaction scores of patients and surgeons, remedial measures, time to chest tube removed and mobilization, adverse effects and hospital stay length were recorded. We also recorded inflammatory markers, respiratory function and the prevalence of chronic pain after surgery. Results: VAS scores at rest and with coughing during the first 24 h after surgery were significantly lower in the P group (P<0.05). Consumption of sevoflurane, remifentanil, and dexmedetomidine was all significantly reduced in the P group (P<0.05). The consumption of sufentanil within 48 h after surgery, time to first dose and total dose of rescue ketorolac was significantly lower in the P group (P<0.05). The FEV1/FVC ratio was significantly higher in the P group at 1 and 3 d after surgery (P<0.05). Times to chest tube removal and mobilization were significantly shorter in the P group (P<0.05). Compared with the C group, the level of both ACTH and cortisol was significantly reduced in the P group at 1 and 3 d after surgery (P<0.05). Conclusion: PVB combined with parecoxib was associated with better pain relief, decreased sufentanil and ketorolac consumption, less hemodynamic instability, and a lower surgery-related stress response. However, the incidences of chronic pain 3 and 6 months after surgery and the risk of complication except urinary retention were not significantly different between groups.

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Surgical trauma‐induced immunosuppression in cancer: Recent advances and the potential therapies

Tang

Tie

et al. 2020

Clinical & Translational Med

104

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Surgical resection remains the mainstay treatment for solid cancers, especially for localized disease. However, the postoperative immunosuppression provides a window for cancer cell proliferation and awakening dormant cancer cells, leading to rapid recurrences or metastases. This immunosuppressive status after surgery is associated with the severity of surgical trauma since immunosuppression induced by minimally invasive surgery is less than that of an extensive open surgery. The systemic response to tissue damages caused by surgical operations and the subsequent wound healing induced a cascade alteration in cellular immunity. After surgery, patients have a high level of circulating damage‐associated molecular patterns (DAMPs), triggering a local and systemic inflammation. The inflammatory metrics in the immediate postoperative period was associated with the prognosis of cancer patients. Neutrophils provide the first response to surgical trauma, and the production of neutrophil extracellular traps (NETs) promotes cancer progression. Activated macrophage during wound healing presents a tumor‐associated phenotype that cancers can exploit for their survival advantage. In addition, the amplification and activation of myeloid‐derived suppressor cells (MDSCs), regulatory T cells (Tregs) or the elevated programmed death ligand‐1 and vascular endothelial growth factor expression under surgical trauma, exacerbate the immunosuppression and favor of the formation of the premetastatic niche. Therapeutic strategies to reduce the cellular immunity impairment after surgery include anti‐DAMPs, anti‐postoperative inflammation or inflammatory/pyroptosis signal, combined immunotherapy with surgery, antiangiogenesis and targeted therapies for neutrophils, macrophages, MDSCs, and Tregs. Further, the application of enhanced recovery after surgery also has a feasible outcome for postoperative immunity restoration. Overall, current therapies to improve the cellular immunity under the special condition after surgery are relatively lacking. Further understanding the underlying mechanisms of surgical trauma‐related immunity dysfunction, phenotyping the immunosuppressive cells, and developing the related therapeutic intervention should be explored.

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Surgical wound-site inflammation: video-assisted thoracic surgery versus thoracotomy

Abstract: The local microenvironment during VATS differs from that of thoracotomy by not producing the same inflammatory phenotype. The clinical efficacy of a less invasive surgical approach is confirmed by a reduced inflammation of the systemic and local districts.

Cited by 15 publications

References 23 publications

Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

Video-assisted thoracoscopic surgery versus muscle-sparing thoracotomy for non-small cell lung cancer: a systematic review and meta-analysis

<p>The Efficacy and Safety of Paravertebral Block Combined with Parecoxib During Video-Assisted Thoracic Surgery: A Randomized Controlled Trial</p>

Surgical trauma‐induced immunosuppression in cancer: Recent advances and the potential therapies

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