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Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity.
Ann Thorac Surg. 2008 Dec; 86(6):1735-44.AT

Abstract

BACKGROUND

Video-assisted thoracoscopic surgery (VATS) for patients with early-stage non-small-cell lung cancer is associated with lower stress responses and potentially improved outcomes, as compared with thoracotomy. The goal of our study was to examine the cellular components of the postoperative immune response. Specifically, we assessed the cytotoxic capacity of peripheral blood mononuclear cells (PBMCs) of patients undergoing lobectomy for non-small-cell lung cancer by either VATS or thoracotomy.

METHODS

We performed a prospective cohort study of lobectomy patients undergoing either VATS or thoracotomy. We isolated PBMCs from perioperative blood samples, and performed cytokine analysis on plasma fractions. Using flow cytometry, we analyzed PBMC phenotype (CD3, CD16/56, CD4, CD8) and T-cell activation markers (CD25, CD69, HLA-DR). Using a chromium release assay, we quantified cellular cytotoxicity. To assess gene expression differences, we used Affymetrix messenger ribonucleic acid microarray and polymerase chain reaction analysis.

RESULTS

A total of 13 patients enrolled in our study: 6, VATS; 7, thoracotomy. On postoperative day 1, interleukin-6 and matrix metalloproteinase-9 were significantly different between the two groups. On day 2, cellular cytotoxicity (0.34) was significantly greater (p < 0.05) after VATS, as compared with thoracotomy (0.18). In both groups, cytotoxicity returned to baseline and was equivalent at first follow-up (VATS, 29.4 days versus thoracotomy, 29.3 days; p > 0.05). We noted minimal yet significant differences in PBMC phenotype, but no differences in T-cell activation makers. A 9-gene polymerase chain reaction-validated subset clustered the two groups with complete concordance.

CONCLUSIONS

Video-assisted thoracoscopic surgery lobectomy for non-small-cell lung cancer is associated with less impairment of cellular cytotoxicity, as compared with thoracotomy. We found that this difference was not accounted for by PBMC phenotypic changes. Instead, PBMC gene expression changes likely represent the molecular basis of this differential immune response.

Authors+Show Affiliations

Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

19021967

Citation

Whitson, Bryan A., et al. "Thoracoscopic Versus Thoracotomy Approaches to Lobectomy: Differential Impairment of Cellular Immunity." The Annals of Thoracic Surgery, vol. 86, no. 6, 2008, pp. 1735-44.
Whitson BA, D'Cunha J, Andrade RS, et al. Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. Ann Thorac Surg. 2008;86(6):1735-44.
Whitson, B. A., D'Cunha, J., Andrade, R. S., Kelly, R. F., Groth, S. S., Wu, B., Miller, J. S., Kratzke, R. A., & Maddaus, M. A. (2008). Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. The Annals of Thoracic Surgery, 86(6), 1735-44. https://doi.org/10.1016/j.athoracsur.2008.07.001
Whitson BA, et al. Thoracoscopic Versus Thoracotomy Approaches to Lobectomy: Differential Impairment of Cellular Immunity. Ann Thorac Surg. 2008;86(6):1735-44. PubMed PMID: 19021967.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Thoracoscopic versus thoracotomy approaches to lobectomy: differential impairment of cellular immunity. AU - Whitson,Bryan A, AU - D'Cunha,Jonathan, AU - Andrade,Rafael S, AU - Kelly,Rosemary F, AU - Groth,Shawn S, AU - Wu,Baolin, AU - Miller,Jeffrey S, AU - Kratzke,Robert A, AU - Maddaus,Michael A, PY - 2008/04/07/received PY - 2008/06/30/revised PY - 2008/07/02/accepted PY - 2008/11/22/pubmed PY - 2009/1/7/medline PY - 2008/11/22/entrez SP - 1735 EP - 44 JF - The Annals of thoracic surgery JO - Ann. Thorac. Surg. VL - 86 IS - 6 N2 - BACKGROUND: Video-assisted thoracoscopic surgery (VATS) for patients with early-stage non-small-cell lung cancer is associated with lower stress responses and potentially improved outcomes, as compared with thoracotomy. The goal of our study was to examine the cellular components of the postoperative immune response. Specifically, we assessed the cytotoxic capacity of peripheral blood mononuclear cells (PBMCs) of patients undergoing lobectomy for non-small-cell lung cancer by either VATS or thoracotomy. METHODS: We performed a prospective cohort study of lobectomy patients undergoing either VATS or thoracotomy. We isolated PBMCs from perioperative blood samples, and performed cytokine analysis on plasma fractions. Using flow cytometry, we analyzed PBMC phenotype (CD3, CD16/56, CD4, CD8) and T-cell activation markers (CD25, CD69, HLA-DR). Using a chromium release assay, we quantified cellular cytotoxicity. To assess gene expression differences, we used Affymetrix messenger ribonucleic acid microarray and polymerase chain reaction analysis. RESULTS: A total of 13 patients enrolled in our study: 6, VATS; 7, thoracotomy. On postoperative day 1, interleukin-6 and matrix metalloproteinase-9 were significantly different between the two groups. On day 2, cellular cytotoxicity (0.34) was significantly greater (p < 0.05) after VATS, as compared with thoracotomy (0.18). In both groups, cytotoxicity returned to baseline and was equivalent at first follow-up (VATS, 29.4 days versus thoracotomy, 29.3 days; p > 0.05). We noted minimal yet significant differences in PBMC phenotype, but no differences in T-cell activation makers. A 9-gene polymerase chain reaction-validated subset clustered the two groups with complete concordance. CONCLUSIONS: Video-assisted thoracoscopic surgery lobectomy for non-small-cell lung cancer is associated with less impairment of cellular cytotoxicity, as compared with thoracotomy. We found that this difference was not accounted for by PBMC phenotypic changes. Instead, PBMC gene expression changes likely represent the molecular basis of this differential immune response. SN - 1552-6259 UR - https://www.unboundmedicine.com/medline/citation/19021967/Thoracoscopic_versus_thoracotomy_approaches_to_lobectomy:_differential_impairment_of_cellular_immunity_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0003-4975(08)01417-3 DB - PRIME DP - Unbound Medicine ER -