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Thorac Cardiovasc Surg 2022; 70(03): 258-264
DOI: 10.1055/s-0041-1731824
Original Thoracic

Systemic Inflammation after Uniport, Multiport, or Hybrid VATS Lobectomy for Lung Cancer

Federico Tacconi
1   Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
,
Federica Carlea
1   Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
,
Eleonora La Rocca
1   Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
,
Gianluca Vanni
1   Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
,
Vincenzo Ambrogi
1   Department of Surgery, Unit of Thoracic Surgery, Tor Vergata University Polyclinic, Rome, Italy
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Abstract

Background Different video-assisted thoracic surgery (VATS) approaches can be adopted to perform lobectomy for non-small cell lung cancer. Given the hypothetical link existing between postoperative inflammation and long-term outcomes, we compared the dynamics of systemic inflammation markers after VATS lobectomy performed with uniportal access (UNIVATS), multiportal access (MVATS), or hybrid approach (minimally invasive hybrid open surgery, MIHOS).

Methods Peripheral blood-derived inflammation markers (neutrophil-to-lymphocyte [NTL] ratio, platelet-to-lymphocyte [PTL] ratio, and systemic immune-inflammation index [SII]) were measured preoperatively and until postoperative day 5 in 109 patients undergoing UNIVATS, MVATS, or MIHOS lobectomy. Differences were compared through repeated-measure analysis of variance, before and after 1:1:1 propensity score matching. Time-to-event analysis was also done by measuring time to NTL normalization, based on the reliability change index for each patient.

Results After UNIVATS, there was a faster decrease in NTL ratio (p = 0.015) and SII (p = 0.019) compared with other approaches. MVATS exhibited more pronounced PTL rebound (p = 0.011). However, all these differences disappeared in matched analysis. After MIHOS, NTL ratio normalization took longer (mean difference: 0.7 ± 0.2 days, p = 0.047), yet MIHOS was not independently associated with slower normalization at Cox's regression analysis (p = 0.255, odds ratio: 1.6, confidence interval: 0.7–4.0). Furthermore, surgical access was not associated with cumulative postoperative morbidity, nor was it with incidence of postoperative pneumonia.

Conclusion In this study, different VATS approaches resulted into unsubstantial differences in postoperative systemic inflammatory response, after adjusting for confounders. The majority of patients returned back to preoperative values by postoperative day 5 independently on the adopted surgical access. Further studies are needed to elaborate whether these small differences may still be relevant to patient management.

Keywords

lung cancer - VATS - systemic inflammation


Publication History

Received: 21 January 2021

Accepted: 15 May 2021

Article published online:
17 August 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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