Systemic inflammatory response and complications developing in patients undergoing lobectomy for non-small-cell lung cancer: thoracotomy versus video-assisted thoracoscopic surgery

Abstract

Purpose The present study investigates the effect of different surgical approaches on the systemic inflammatory response and the development of complications in patients undergoing lobectomy for non-small-cell lung cancer. Methods The data of 223 patients who underwent lobectomy for non-small-cell lung cancer via either thoracotomy or video-assisted thoracoscopic surgery (VATS) between 2015 and 2023 were analyzed retrospectively. Neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV) were used to assess inflammatory response. Results Of the patients included in the study, 39 (17.5%) were female and 184 (82.5%) were male, and mean age was 63.46 (standard deviation (SD) 10.24) years (min 18-max 84). Of the sample, 59 (26.5%) underwent lobectomy via VATS and 164 (73.5%) via thoracotomy. Delta NLR, delta SII, and delta PIV were all found to be higher in the thoracotomy group than in the VATS group (p < 0.001, p < 0.001, p = 0.002, respectively). In a univariate analysis examining development of complications, delta NLR and delta SII were significantly higher in the group with complications (p = 0.020, p = 0.026, respectively), while no significant difference was observed in delta PIV (p = 0.066). In multivariable linear regression models adjusted for age, gender, presence of comorbidity, tumor location, tumor size, lymph node involvement, tumor stage, and surgical method, thoracotomy was associated with a greater increase in delta NLR (p = 0.016), as well as approximately 71% and 84% greater increases in delta SII and delta PIV, respectively (p = 0.013 and p = 0.003). Conclusion The present study revealed that patients who underwent lobectomy via VATS for non-small-cell lung cancer had a lower systemic inflammatory response than those undergoing lobectomy via thoracotomy. The increase in inflammatory markers, including NLR, SII, and PIV, was more remarkable in patients undergoing thoracotomy.