Immunologic and Stress Responses Following Video-Assisted Thoracic Surgery and Open Pulmonary Lobectomy in Early Stage Lung Cancer
Section snippets
The stress response
Multiple inputs contribute to and modify the surgical response to injury (Fig. 1). This process may be considered as having endocrine, neural, and immunologic components [1], all of which are subject to varying degrees of mutual interaction (Box 1).
The evolution of our understanding of the stress response to surgery has been reviewed in detail elsewhere [2], and the general metabolic response to surgery is summarized in Table 1. The importance of neural afferent stimuli in the generation of the
Relationship between immune mechanisms and cancer
Patients who have lung cancer undergo major stress against a background of preexisting compromise. For example, CD4, CD8, and natural killer (NK) cell numbers are already suppressed in this group [7]. Therefore, it is relevant to briefly consider the current thinking with regard to immune mechanisms and cancer. This is well reviewed elsewhere [8], [9], [10], [11].
Adaptive immunity (ie, that related to antibody production) has limited relevance because tumors generally (and lung cancer, in
Endocrine and neuroendocrine responses
Endocrine and sympathetic nervous system responses to surgery have been studied in some detail in relation to a wide range of laparoscopic procedures, including cholecystectomy, herniorrhaphy, colonic resection, hysterectomy, and various other procedures and reviewed in detail by Kehlet [13]. Typically, corticotropin, cortisol, prolactin, and catecholamines were studied. In general, there is little evidence for a significant difference in endocrine responses between open and laparoscopic
Discussion
The studies available for comparison between open and minimal access surgery have important limitations. As in many areas, we may be “measuring the measurable rather than the meaningful.” Tissue active cytokines and other immunomodulatory factors may exhibit localized plasma and tissue levels. Sampling times are, of necessity, fixed, and therefore, may miss effects. Also, much of the area of greatest interest (ie, local immune mechanisms) involves interactions within microsystems (eg, the
Acknowledgments
We are grateful to Dr. Dino Rotondo (Strathclyde University, Glasgow, UK) and Dr. Maria Teresa Rizzo (Signal Transduction Laboratory, Indianapolis, Indiana) for critical analysis of the manuscript.
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