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Eur J Cardiothorac Surg 2007;31:83-87. doi:10.1016/j.ejcts.2006.10.019
Copyright © 2007, European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved

Video-assisted thoracic surgery lobectomy for lung cancer is associated with less immunochemokine disturbances than thoracotomy

Division of Cardiothoracic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, N.T., Hong Kong SAR, China

Received 16 June 2006; received in revised form 13 October 2006; accepted 23 October 2006.

^_* Corresponding author. Address: The Chinese University of Hong Kong, Prince of Wales Hospital & Minimally Invasive Center, Union Hospital, Shatin, N.T., Hong Kong SAR, China. Tel.: +852 2632 2629; fax: +852 2647 8273. (Email: yimap{at}cuhk.edu.hk).

Objective: Major surgery is immunosuppressive and could have an impact on postoperative tumor immunosurveillance and recurrence in cancer patients. Low circulating levels of insulin growth factor binding protein (IGFBP)-3 have been linked to advance prostate and the development of colonic cancers. This prospective study examined the early postoperative circulating levels of IGFBP-3, matrix metalloproteinase (MMP)-9, and tissue inhibitor of metalloproteinase (TIMP)-1 in early stage non-small cell lung cancer (NSCLC) patients undergoing major lung resection by VATS versus thoracotomy. Methods: Forty-two consecutive patients with resectable primary NSCLC were assigned to VATS or thoracotomy approach over a 7-month-period. Blood samples were collected preoperatively and postoperatively on days (POD) 1 and 3 for enzyme linked immunosorbent assay determination of IGFBP-3, MMP-9 and TIMP-1 levels in the serum. Results: There were no demographic differences between the two groups. VATS lung resection was associated with lower levels of MMP-9 and TIMP-1 on POD1 (median 628 vs 1311 ng/ml, p = 0.009; and 131 vs 211 ng/ml, p = 0.004, respectively) but higher levels of IGFBP-3 on POD3 (1366 vs 1144 ng/ml, p = 0.02), when compared with the thoracotomy approach. There was no perioperative mortality. Conclusions: VATS major lung resection for NSCLC is associated with higher circulating levels of IGFBP-3, and lower levels of MMP-9 and TIMP-1, compared to the thoracotomy approach. The clinical relevance of these postoperative changes on tumor biology following lung resection for cancer warrants further investigation.

Key Words: Insulin growth factor binding protein (IGFBP)-3 • Lung cancer • Matrix metalloproteinase (MMP)-9 • Tissue inhibitor of metalloproteinase (TIMP)-1 • Video-assisted thoracic surgery (VATS)