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Cytokine Gene Expression After Lung Cancer Resection May Be Affected by the Choice of Surgical AccessSurgical Approach and Cytokine Gene Expression FREE TO VIEW

Michael K. Y. Hsin, MD; Song Wan, MD; Anthony P. C. Yim, MD, FCCP
Author and Funding Information

From the Department of Surgery, The Chinese University of Hong Kong.

Correspondence to: Michael K. Y. Hsin, MD, Department of Surgery, The Prince of Wales Hospital, Shatin, New Territories, Hong Kong. e-mail: michaelhsin@surgery.cuhk.edu.hk


Financial/nonfinancial disclosures: The authors have reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):830-831. doi:10.1378/chest.11-0795
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To the Editor:

We read with interest the article by White et al1 in a recent issue of CHEST (March 2011), which proposed that based on cytokine gene expression, algorithms can be developed that may help identify patients who are at increased risk of hospital-acquired pneumonia following major lung resection. The authors acknowledged that the extent of tissue trauma can affect the inflammatory and immune response to surgery. It is noteworthy that the choice of surgical approach for the cancer resection has a significant impact on the extent of access trauma and the subsequent modulation of the immune response. Vittimberga and colleagues2 reviewed the literature on laparoscopy vs laparotomy and concluded that surgical trauma can cause a systemic inflammatory cytokine response, resulting in increased circulating levels of IL-1, IL-6, and tumor necrosis factor-α; however, the body’s response to laparoscopy is one of lesser immune activation as opposed to immunosuppression. Traditionally, lung cancer resection has been performed using open thoracotomy, but recently there has been increased use of video-assisted thoracic surgery (VATS).3 In patients with stage I non-small cell lung cancer who underwent lung resection either using VATS or open thoracotomy, we showed3 that the plasma levels of IL-6, IL-8, and IL-10 were elevated in both groups. However, the IL-6 and IL-8 levels were significantly lower in the VATS group at the end of surgery than in the open group. Moreover, reduced release of IL-10 was also observed in the VATS group.4 Craig et al5 also showed that compared with open thoracotomy, VATS was associated with lower C-reactive protein and IL-6 levels. In the study by White et al,4 the entire cohort underwent open thoracotomy.

A literature search failed to identify any study that addressed cytokine gene expression following lung resection as a function of different surgical access. It is probable that if the VATS approach was included, the postoperative cytokine gene expression might differ depending on the choice of surgical access, and this may have important implications for the proposed algorithm to identify patients at increased risk of postoperative pneumonia. Further studies are needed to investigate whether the extent of tissue trauma caused by VATS vs thoracotomy may result in different cytokine gene expression. If this is confirmed, then the treatment algorithm suggested by White et al1 should be constructed taking into account the impact of different surgical approaches.

White M, Martin-Loeches I, Lawless MW, et al. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression. Chest. 2011;1393:626-632 [CrossRef] [PubMed]
 
Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP. Laparoscopic surgery and the systemic immune response. Ann Surg. 1998;2273:326-334 [CrossRef] [PubMed]
 
Scott WJ, Allen MS, Darling G, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;1394:976-981 [CrossRef] [PubMed]
 
Yim APC, Wan S, Lee TW, Arifi AA. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg. 2000;701:243-247 [CrossRef] [PubMed]
 
Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;203:455-463 [CrossRef] [PubMed]
 

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References

White M, Martin-Loeches I, Lawless MW, et al. Hospital-acquired pneumonia after lung resection surgery is associated with characteristic cytokine gene expression. Chest. 2011;1393:626-632 [CrossRef] [PubMed]
 
Vittimberga FJ Jr, Foley DP, Meyers WC, Callery MP. Laparoscopic surgery and the systemic immune response. Ann Surg. 1998;2273:326-334 [CrossRef] [PubMed]
 
Scott WJ, Allen MS, Darling G, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;1394:976-981 [CrossRef] [PubMed]
 
Yim APC, Wan S, Lee TW, Arifi AA. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg. 2000;701:243-247 [CrossRef] [PubMed]
 
Craig SR, Leaver HA, Yap PL, Pugh GC, Walker WS. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg. 2001;203:455-463 [CrossRef] [PubMed]
 
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