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Systematic mediastinal lymphadenectomy does not increase postoperative immune response after major lung resections

Tomasz Jarosaw Szczsny^a,d,_*, Robert Sotwiski^b,e,f, Bruno Szczygie^c, Aleksander Stankiewicz^d, Marzanna Zaleska^e, Maria Kopacz^f, Aleksandra Olesiska-Grod^g

^a Department of Thoracic Surgery, Regional Lung Diseases Hospital, Prabuty, Poland
^b Department of Immunology and Nutrition, Medical University, Warsaw, Poland
^c Department of Human Nutrition, Medical University, Warsaw, Poland
^d Olsztyn City Hospital, Olsztyn, Poland
^e Department of Surgical Research and Transplantology, Medical Research Center, Polish Academy of Sciences, Warsaw, Poland
^f Department of General, Gastroenterologic Surgery and Nutrition, Medical University, Warsaw, Poland
^g Hospital Laboratory, Regional Lung Diseases Hospital, Prabuty, Poland

Received 2 June 2007; received in revised form 28 August 2007; accepted 3 September 2007.

^_* Corresponding author. Address: Department of Thoracic Surgery, Regional Lung Diseases Hospital, 30 Kuracyjna Str., 82-550 Prabuty, Poland. Tel.: +48 55 2624 377; fax: +48 55 2782 435. (Email: szczesny{at}lungcancer.med.pl).

Objective: To assess the influence of mediastinal lymphadenectomy on postoperative concentration of interleukin 6 (IL-6) and interleukin 1 receptor antagonist (IL-1ra) in serum, sputum, and pleural fluid, in patients operated upon due to lung cancer and benign pulmonary diseases. Methods: Thirty-three patients undergoing uncomplicated resections, including 23 with lung cancer and 10 with benign diseases, were analyzed. In patients with right lung cancer we performed a systematic lymphadenectomy, while in patients with left lung cancer systematic sampling was performed. Serum IL-6 and IL-1ra concentration was measured before and after surgery, and on postoperative days 1, 3, and 7, as well as in sputum at the end of surgery and in pleural fluid on postoperative day 1, by ELISA test. Results: In 23 patients with cancer, 19.0 ± 11.43 mediastinal lymph nodes were removed (in 11 patients with right lung cancer 27.6 ± 7.6 and in 12 patients with left lung cancer 11.1 ± 8.1). No differences were found in serum and sputum concentration of IL-6 and IL-1ra between patients after right and left thoracotomy due to cancer and between patients with cancer and patients with benign diseases. Patients with cancer had a lower concentration of IL-1ra in pleural fluid (median 16950, range 16050–45470.05 pg/ml) than patients with benign diseases (76665.6 pg/ml (range 53618–89617.9); p = 0.0008). In 23 cancer patients a negative correlation between concentration of cytokines in pleural fluid and a number of mediastinal lymph nodes resected was observed (Spearman correlation coefficient for IL-6: r = –0.44, p = 0.04; for IL-1ra: r = –0.57, p = 0.01). Such correlation was not observed for a number of positive N2 lymph nodes. Conclusions: Systematic lymphadenectomy added to major lung resection does not increase postoperative humoral immune response in uncomplicated cases, as measured by levels of IL-6 and IL-1ra in serum, pleural fluid, and sputum.

Key Words: NSCLC • Lung cancer • Mediastinal lymphadenectomy • IL-6 • IL-1ra