Comparison of postoperative immune function between da Vinci robot-assisted and video-assisted thoracoscopic surgery in patients with non-small cell lung cancer_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

XUE Jialong ^1,2 , XU Wei ² , LIU Xingchi ² , LIU Bo ² , XU Shiguang ² , HU Boxiao ² , GONG Xiaokang ² , LI Xu ² ,  WANG Shumin ²

1. Graduate Training Base of General Hospital of Northern Theater Command, Jinzhou Medical University, Shenyang, 110016, P.R.China;
2. Department of Thoracic Surgery, General Hospital of Northern Theater Command, Shenyang, 110016, P.R.China;

Corresponding author：

WANG Shumin, Email: sureman2003congo@163.com

Keywords：

Non-small cell lung cancer; da Vinci robot-assisted thoracoscopic surgery; video-assisted thoracoscopic surgery; immune function

DOI：

10.7507/1007-4848.202010063

Video：

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Objective To compare the effect on postoperative immune function between da Vinci robot-assisted thoracoscopic surgery (RATS) and video-assisted thoracoscopic surgery (VATS) , and to provide clinical support for more effective surgical procedures.Methods A total of 90 patients undergoing radical resection of pulmonary carcinoma in our hospital from June to November 2019 were included. There were 49 males and 41 females with an average age of 62.67 (37-84) years. Among them, 50 patients underwent da Vinci robot-assisted thoracoscopic surgery (a RATS group) and 40 patients underwent video-assisted thoracoscopic surgery (a VATS group). The perioperative indexes as well as postoperative inflammatory factors and immune level effects between the two groups were compared.Results Compared with the VATS, RATS could significantly shorten the operation time and decrease intraoperative blood loss (P<0.05). RATS also effectively reduced the increase of postoperative inflammatory factor level (P<0.05). But there was no significant difference in postoperative immune function between the RATS group and the VATS group (P>0.05).Conclusion RATS is superior to VATS in the treatment of non-small cell lung cancer in perioperative indicators and inflammatory factors.

Citation： XUE Jialong, XU Wei, LIU Xingchi, LIU Bo, XU Shiguang, HU Boxiao, GONG Xiaokang, LI Xu, WANG Shumin. Comparison of postoperative immune function between da Vinci robot-assisted and video-assisted thoracoscopic surgery in patients with non-small cell lung cancer. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(5): 534-539. doi: 10.7507/1007-4848.202010063 Copy

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7.	Garbutt AM. Working towards clinical effectiveness—A multi-disciplinary approach to robotic surgery. Ann Cardiothorac Surg, 2019, 8(2): 255-262.
8.	Kanzaki M. Current status of robot-assisted thoracoscopic surgery for lung cancer. Surg Today, 2019, 49(10): 795-802.
9.	Brooks P. Robotic-assisted thoracic surgery for early-stage lung cancer: A review. Aorn J, 2015, 102(1): 40-49.
10.	Augustin F, Bodner J, Wykypiel H, et al. Initial experience with robotic lung lobectomy: Report of two different approaches. Surg Endosc, 2011, 25(1): 108-113.
11.	Veronesi G, Novellis P, Difrancesco O, et al. Robotic assisted lobectomy for locally advanced lung cancer. J Vis Surg, 2017, 3: 78-78.
12.	Guo F, Ma DJ, Li SQ. Compare the prognosis of Da Vinci robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS) for non-small cell lung cancer: A meta-analysis. Medicine, 2019, 98(39): e17089.
13.	Arnold BN, Thomas DC, Bhatnagar V, et al. Defining the learning curve in robot-assisted thoracoscopic lobectomy. Surgery, 2019, 165(2): 450-454.
14.	Oh DS, Reddy RM, Gorrepati ML, et al. Robotic-assisted, video-assisted thoracoscopic and open lobectomy: Propensity-matched analysis of recent premier data. Ann Thorac Surg, 2017, 104(5): 1733-1740.
15.	Takagi H, Yamamoto H, Goto SN, et al. Perioperative results of robotic lung lobectomy: Summary of the literature. Surg Endosc, 2012, 26(12): 3697-3699.
16.	Ogawa K, Hirai M, Katsube T, et al. Suppression of cellular immunity by surgical stress. Surgery, 2000, 127(3): 329-336.
17.	Menna C, De Falco E, Teodonio L, et al. Surgical wound-site inflammation: Video-assisted thoracic surgery versus thoracotomy. Interact Cardiovasc Thorac Surg, 2019, 28(2): 240-246.
18.	Boo YJ, Kim WB, Kim J, et al. Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: A prospective randomized study. Scand J Clin Lab Inv, 2007, 67(2): 207-214.
19.	Andreetti C, Menna C, Ibrahim M, et al. Postoperative pain control: Videothoracoscopic versus conservative mini-thoracotomic approach. Eur J Cardiothorac Surg, 2014, 46(5): 907-912.
20.	Cao C, Zhu ZH, Yan TD, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small-cell lung cancer: A propensity score analysis based on a multi-institutional registry. Eur J Cardiothorac Surg, 2013, 44(5): 849-854.
21.	White FA, Bhangoo SK, Miller RJ. Chemokines: Integrators of pain and inflammation. Nat Rev Drug Discov, 2005, 4(10): 834-844.
22.	Novitsky YW, Litwin DE, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc, 2004, 18(10): 1411-1419.
23.	Walker WS, Leaver HA. Immunologic and stress responses following video-assisted thoracic surgery and open pulmonary lobectomy in early stage lung cancer. Thorac Surg Clin, 2007, 17(2): 241-249.
24.	Yim AP, Wan S, Lee TW, et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg, 2000, 70(1): 243-247.
25.	Zhang LB, Wang B, Wang XY, et al. Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients. Med Oncol, 2015, 32(7): 204.
26.	Leaver HA, Craig SR, Yap PL, et al. Lymphocyte responses following open and minimally invasive thoracic surgery. Eur J Clin Invest, 2000, 30(3): 230-238.
27.	降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识. 中华急诊医学杂志, 2012, 21(9): 944-951.
28.	Cao M, Chen W. Epidemiology of lung cancer in China. Thorac Cancer, 2019, 10(1): 3-7.
29.	Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin, 2018, 68(1): 7-30.
30.	Lu T, Yang X, Huang Y, et al. Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades. Cancer Manag Res, 2019, 11: 943-953.
31.	Martín-Sánchez JC, Lunet N, González-Marrón A, et al. Projections in breast and lung cancer mortality among women: A bayesian analysis of 52 countries worldwide. Cancer Res, 2018, 78(15): 4436-4442.
32.	代锋, 许世广, 徐惟, 等. 达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究. 中国肺癌杂志, 2018, 21(3): 206-211.
33.	Melfi FM, Mussi A. Robotically assisted lobectomy: Learning curve and complications. Thorac Surg Clin, 2008, 18(3): 289-295.
34.	Nakamura H. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer. Ann Thorac Cardiovasc Surg, 2014, 20(2): 93-98.
35.	Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer: Report of 100 consecutive cases. Ann Thorac Surg, 2009, 88(2): 380-384.
36.	Schneider T, Hoffmann H, Dienemann H, et al. Immune response after radiofrequency ablation and surgical resection in nonsmall cell lung cancer. Semin Thorac Cardiovasc Surg, 2016 Summer, 28(2): 585-592.
37.	中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识. 中华结核和呼吸杂志, 2017, 40(4): 243-256.
38.	Raeburn CD, Sheppard F, Barsness KA, et al. Cytokines for surgeons. Am J Surg, 2002, 183(3): 268-273.
39.	Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med, 1999, 340(6): 448-454.
40.	Craig SR, Leaver HA, Yap PL, et al. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg, 2001, 20(3): 455-463.
41.	张午临, 刘晖, 贾涛, 等. 胸腔镜小切口手术对非小细胞肺癌患者 CRP、TNF-α及 IL-6 等指标水平的影响. 实用癌症杂志, 2014, 29(10): 1294-1297.
42.	Yamada T, Hisanaga M, Nakajima Y, et al. Serum interleukin-6, interleukin-8, hepatocyte growth factor, and nitric oxide changes during thoracic surgery. World J Surg, 1998, 22(8): 783-790.
43.	O'Grady NP, Barie PS, Bartlett JG, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med, 2008, 36(4): 1330-1349.
44.	Vittimberga FJ, Foley DP, Meyers WC, et al. Laparoscopic surgery and the systemic immune response. Ann Surg, 1998, 227(3): 326-334.
45.	Ito Y, Oda M, Tsunezuka Y, et al. Reduced perioperative immune response in video-assisted versus open surgery in a rat model. Surg Today, 2009, 39(8): 682-688.
46.	郑威, 黄杰. 胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响. 实用癌症杂志, 2017, 32(2): 295-298.

1. World Health Organization. Cancer today: Data visualization tools for exploring the global cancer burden in 2018. http://gco.iarc.fr/today/home.
2. 郑荣寿, 孙可欣, 张思维, 等. 2015 年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
3. Lim E, Baldwin D, Beckles M, et al. Guidelines on the radical management of patients with lung cancer. Thorax, 2010, 65 (Suppl 3): iii1-iii27.
4. Kent M, Wang T, Whyte R, et al. Open, video-assisted thoracic surgery, and robotic lobectomy: Review of a national database. Ann Thorac Surg, 2014, 97(1): 236-242.
5. McKenna RJ. Lobectomy by video-assisted thoracic surgery with mediastinal node sampling for lung cancer. J Thorac Cardiovasc Surg, 1994, 107(3): 879-881.
6. Bodner J, Wykypiel H, Wetscher G, et al. First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg, 2004, 25(5): 844-851.
7. Garbutt AM. Working towards clinical effectiveness—A multi-disciplinary approach to robotic surgery. Ann Cardiothorac Surg, 2019, 8(2): 255-262.
8. Kanzaki M. Current status of robot-assisted thoracoscopic surgery for lung cancer. Surg Today, 2019, 49(10): 795-802.
9. Brooks P. Robotic-assisted thoracic surgery for early-stage lung cancer: A review. Aorn J, 2015, 102(1): 40-49.
10. Augustin F, Bodner J, Wykypiel H, et al. Initial experience with robotic lung lobectomy: Report of two different approaches. Surg Endosc, 2011, 25(1): 108-113.
11. Veronesi G, Novellis P, Difrancesco O, et al. Robotic assisted lobectomy for locally advanced lung cancer. J Vis Surg, 2017, 3: 78-78.
12. Guo F, Ma DJ, Li SQ. Compare the prognosis of Da Vinci robot-assisted thoracic surgery (RATS) with video-assisted thoracic surgery (VATS) for non-small cell lung cancer: A meta-analysis. Medicine, 2019, 98(39): e17089.
13. Arnold BN, Thomas DC, Bhatnagar V, et al. Defining the learning curve in robot-assisted thoracoscopic lobectomy. Surgery, 2019, 165(2): 450-454.
14. Oh DS, Reddy RM, Gorrepati ML, et al. Robotic-assisted, video-assisted thoracoscopic and open lobectomy: Propensity-matched analysis of recent premier data. Ann Thorac Surg, 2017, 104(5): 1733-1740.
15. Takagi H, Yamamoto H, Goto SN, et al. Perioperative results of robotic lung lobectomy: Summary of the literature. Surg Endosc, 2012, 26(12): 3697-3699.
16. Ogawa K, Hirai M, Katsube T, et al. Suppression of cellular immunity by surgical stress. Surgery, 2000, 127(3): 329-336.
17. Menna C, De Falco E, Teodonio L, et al. Surgical wound-site inflammation: Video-assisted thoracic surgery versus thoracotomy. Interact Cardiovasc Thorac Surg, 2019, 28(2): 240-246.
18. Boo YJ, Kim WB, Kim J, et al. Systemic immune response after open versus laparoscopic cholecystectomy in acute cholecystitis: A prospective randomized study. Scand J Clin Lab Inv, 2007, 67(2): 207-214.
19. Andreetti C, Menna C, Ibrahim M, et al. Postoperative pain control: Videothoracoscopic versus conservative mini-thoracotomic approach. Eur J Cardiothorac Surg, 2014, 46(5): 907-912.
20. Cao C, Zhu ZH, Yan TD, et al. Video-assisted thoracic surgery versus open thoracotomy for non-small-cell lung cancer: A propensity score analysis based on a multi-institutional registry. Eur J Cardiothorac Surg, 2013, 44(5): 849-854.
21. White FA, Bhangoo SK, Miller RJ. Chemokines: Integrators of pain and inflammation. Nat Rev Drug Discov, 2005, 4(10): 834-844.
22. Novitsky YW, Litwin DE, Callery MP. The net immunologic advantage of laparoscopic surgery. Surg Endosc, 2004, 18(10): 1411-1419.
23. Walker WS, Leaver HA. Immunologic and stress responses following video-assisted thoracic surgery and open pulmonary lobectomy in early stage lung cancer. Thorac Surg Clin, 2007, 17(2): 241-249.
24. Yim AP, Wan S, Lee TW, et al. VATS lobectomy reduces cytokine responses compared with conventional surgery. Ann Thorac Surg, 2000, 70(1): 243-247.
25. Zhang LB, Wang B, Wang XY, et al. Influence of video-assisted thoracoscopic lobectomy on immunological functions in non-small cell lung cancer patients. Med Oncol, 2015, 32(7): 204.
26. Leaver HA, Craig SR, Yap PL, et al. Lymphocyte responses following open and minimally invasive thoracic surgery. Eur J Clin Invest, 2000, 30(3): 230-238.
27. 降钙素原急诊临床应用专家共识组. 降钙素原(PCT)急诊临床应用的专家共识. 中华急诊医学杂志, 2012, 21(9): 944-951.
28. Cao M, Chen W. Epidemiology of lung cancer in China. Thorac Cancer, 2019, 10(1): 3-7.
29. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin, 2018, 68(1): 7-30.
30. Lu T, Yang X, Huang Y, et al. Trends in the incidence, treatment, and survival of patients with lung cancer in the last four decades. Cancer Manag Res, 2019, 11: 943-953.
31. Martín-Sánchez JC, Lunet N, González-Marrón A, et al. Projections in breast and lung cancer mortality among women: A bayesian analysis of 52 countries worldwide. Cancer Res, 2018, 78(15): 4436-4442.
32. 代锋, 许世广, 徐惟, 等. 达芬奇机器人与电视胸腔镜辅助非小细胞肺癌根治术近期疗效配对的病例对照研究. 中国肺癌杂志, 2018, 21(3): 206-211.
33. Melfi FM, Mussi A. Robotically assisted lobectomy: Learning curve and complications. Thorac Surg Clin, 2008, 18(3): 289-295.
34. Nakamura H. Systematic review of published studies on safety and efficacy of thoracoscopic and robot-assisted lobectomy for lung cancer. Ann Thorac Cardiovasc Surg, 2014, 20(2): 93-98.
35. Gharagozloo F, Margolis M, Tempesta B, et al. Robot-assisted lobectomy for early-stage lung cancer: Report of 100 consecutive cases. Ann Thorac Surg, 2009, 88(2): 380-384.
36. Schneider T, Hoffmann H, Dienemann H, et al. Immune response after radiofrequency ablation and surgical resection in nonsmall cell lung cancer. Semin Thorac Cardiovasc Surg, 2016 Summer, 28(2): 585-592.
37. 中国医药教育协会感染疾病专业委员会. 感染相关生物标志物临床意义解读专家共识. 中华结核和呼吸杂志, 2017, 40(4): 243-256.
38. Raeburn CD, Sheppard F, Barsness KA, et al. Cytokines for surgeons. Am J Surg, 2002, 183(3): 268-273.
39. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med, 1999, 340(6): 448-454.
40. Craig SR, Leaver HA, Yap PL, et al. Acute phase responses following minimal access and conventional thoracic surgery. Eur J Cardiothorac Surg, 2001, 20(3): 455-463.
41. 张午临, 刘晖, 贾涛, 等. 胸腔镜小切口手术对非小细胞肺癌患者 CRP、TNF-α及 IL-6 等指标水平的影响. 实用癌症杂志, 2014, 29(10): 1294-1297.
42. Yamada T, Hisanaga M, Nakajima Y, et al. Serum interleukin-6, interleukin-8, hepatocyte growth factor, and nitric oxide changes during thoracic surgery. World J Surg, 1998, 22(8): 783-790.
43. O'Grady NP, Barie PS, Bartlett JG, et al. Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America. Crit Care Med, 2008, 36(4): 1330-1349.
44. Vittimberga FJ, Foley DP, Meyers WC, et al. Laparoscopic surgery and the systemic immune response. Ann Surg, 1998, 227(3): 326-334.
45. Ito Y, Oda M, Tsunezuka Y, et al. Reduced perioperative immune response in video-assisted versus open surgery in a rat model. Surg Today, 2009, 39(8): 682-688.
46. 郑威, 黄杰. 胸腔镜肺叶切除术对非小细胞肺癌患者炎性因子及免疫功能的影响. 实用癌症杂志, 2017, 32(2): 295-298.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Comparison of postoperative immune function between da Vinci robot-assisted and video-assisted thoracoscopic surgery in patients with non-small cell lung cancer

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