Pages: 1016-1021DOI: 10.46327/msrjg.1.000000000000206
Date of Publication: 30-Nov--0001
Early Postoperative Results of Patients Undergoing Uniportal Video-Assisted Thoracoscopic Lobectomy and Their Assessment with The Systemic Inflammation Scoring System
Author: Burcu Ancin, Serkan Uysal, Erkan Dikmen, Riza Dogan
Category: JMSR Surgery
Background __ampersandsign Aim: Uniportal video-assisted thoracoscopic surgery (u-VATS) is a minimally invasive approach that allows thoracic operations to be performed through a single small incision of approximately 4 cm. The Systemic Inflammation Score (SIS) is a scoring system that can be measured easily and inexpensively in routine clinical practice and consists of three laboratory parameters, which are serum albumin level, lymphocyte count, and monocyte count. Scoring systems can provide low-cost and easily attainable objective information that can assist surgeons in evaluating patients. The aim of this study was to examine the early postoperative results of patients who underwent u-VATS lobectomy and to evaluate the relationship of these results with the systemic inflammation scoring system. Methods: Age, gender, smoking habits, preoperative lymphocyte and monocyte counts, preoperative albumin values, comorbidities, operative times, length of hospital stay, chest tube removal time, duration of air leak, amount of drainage, and postoperative complications of patients who underwent u-VATS lobectomy operation in our clinic between March 2018 and March 2020 were retrospectively analyzed. Patients were classified by the SIS based on preoperative serum albumin (ALB) level and lymphocyte-to-monocyte ratio (LMR) as follows: SIS=0, ALB ?4.0 g/dL and LMR ?3.4; SIS=1, ALB <4.0 g/dL or LMR <3.4; and SIS=2, ALB <4.0 g/dL and LMR <3.4. Results: The number of patients who underwent u-VATS lobectomy was 42. There were 12 patients in the SIS 0 group, 19 patients in the SIS 1 group, and 11 patients in the SIS 2 group. The amount of postoperative drainage (p=0.000), chest tube removal time (p=0.006), and length of hospital stay (p=0.000) were correlated with systemic inflammatory scores of patients. The rate of developing postoperative complications was found to increase to almost a statistically significant level as the systemic inflammatory scores of patients increased (p=0.084). There was no significant difference between the SIS groups in terms of other parameters. Conclusion: Patients who underwent u-VATS lobectomy and had a high preoperative systemic inflammation score had higher amounts of postoperative drainage, longer duration of chest tube and length of hospital stay. The SIS scoring system is a simple, effective risk stratification method that can be routinely used for patients undergoing u-VATS lobectomy.
Keywords: Uniportal Video-Assisted Thoracoscopy, Lobectomy, Systemic Inflammation Scoring System, Thoracic Surgery
- Gonzalez-Rivas D, Paradela M, Fernandez R, et al. Uniportal video-assisted thoracoscopic lobectomy: two years of experience. The Annals of Thoracic Surgery. 2013;95(2):426-32.
- Gonzalez-Rivas D, Fieira E, Delgado M, Mendez L, Fernandez R, de la Torre M. Uniportal video-assisted thoracoscopic lobectomy. J Thorac Dis. 2013 Aug;5 Suppl 3(Suppl 3):234-45.
- Wang L, Liu D, Lu J, Zhang S, Yang X. The feasibility and advantage of uniportal video-assisted thoracoscopic surgery (VATS) in pulmonary lobectomy. BMC cancer. 2017;17(1):75.
- Li S, Wang Z, Zhang W, Li J, Zhou K, Che G. Systemic inflammation score: a novel risk stratification tool for postoperative outcomes after video-assisted thoracoscopic surgery lobectomy for early-stage non-small-cell lung cancer. Cancer Manag Res. 2019 Jun 21;11:5613-5628.
- Chang Y, An H, Xu L, Zhu Y, Yang Y, Lin Z, Xu J. Systemic inflammation score predicts postoperative prognosis of patients with clear-cell renal cell carcinoma. Br J Cancer. 2015 Aug 11;113(4):626-33.
- Rocco G, Martin-Ucar A, Passera E. Uniportal VATS wedge pulmonary resections. Ann Thorac Surg. 2004 Feb;77(2):726-8.
- Andreetti C, Menna C, Ibrahim M, Ciccone AM, D'Andrilli A, Venuta F, Rendina EA. Postoperative pain control: videothoracoscopic versus conservative mini-thoracotomic approach. Eur J Cardiothorac Surg. 2014 Nov;46(5):907-12.
- Gonzalez-Rivas D, Fernandez R, Fieira E, Rellan L. Uniportal video-assisted thoracoscopic bronchial sleeve lobectomy: first report. J Thorac Cardiovasc Surg. 2013 Jun;145(6):1676-7.
- McMillan DC. Systemic inflammation, nutritional status and survival in patients with cancer. Curr Opin Clin Nutr Metab Care. 2009 May;12(3):223-6.
- Sato B, Kanda M, Tanaka C, Kobayashi D, Iwata N, Hattori N, Suenaga M, Hayashi M, Yamada S, Murotani K, Fujiwara M, Kodera Y. Significance of Preoperative Systemic Inflammation Score in Short-Term and Long-Term Outcomes of Patients with Pathological T2-4 Gastric Cancer After Radical Gastrectomy. World J Surg. 2018 Oct;42(10):3277-3285
- Lin JX, Lin JP, Xie JW, Wang JB, Lu J, Chen QY, Cao LL, Lin M, Tu R, Zheng CH, Huang CM, Li P. Prognostic importance of the preoperative modified systemic inflammation score for patients with gastric cancer. Gastric Cancer. 2019 Mar;22(2):403-412.
- Li S, Zhang W, Yang Z, Li Y, Du H, Che G. Systemic Inflammation Score as a Novel Prognostic Indicator for Patients Undergoing Video-Assisted Thoracoscopic Surgery Lobectomy for Non-Small-Cell Lung Cancer. J Invest Surg. 2021 Apr;34(4):428-440.
- Shiels MS, Katki HA, Freedman ND, Purdue MP, Wentzensen N, Trabert B, Kitahara CM, Furr M, Li Y, Kemp TJ, Goedert JJ, Chang CM, Engels EA, Caporaso NE, Pinto LA, Hildesheim A, Chaturvedi AK. Cigarette smoking and variations in systemic immune and inflammation markers. J Natl Cancer Inst. 2014 Oct 1;106(11):dju294.
- Arnson Y, Shoenfeld Y, Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. J Autoimmun. 2010 May;34(3):J258-65.
- Cui WY, Li MD. Nicotinic modulation of innate immune pathways via α7 nicotinic acetylcholine receptor. J Neuroimmune Pharmacol. 2010 Dec;5(4):479-88
- Zhou T, Zhao Y, Zhao S, Yang Y, Huang Y, Hou X, Zhao H, Zhang L. Comparison of the Prognostic Value of Systemic Inflammation Response Markers in Small Cell Lung Cancer Patients. J Cancer. 2019 Apr 3;10(7):1685-1692.
- Kaye KS, Marchaim D, Chen TY, Baures T, Anderson DJ, Choi Y, Sloane R, Schmader KE. Effect of nosocomial bloodstream infections on mortality, length of stay, and hospital costs in older adults. J Am Geriatr Soc. 2014 Feb;62(2):306-11.
- Watt DG, McSorley ST, Park JH, Horgan PG, McMillan DC. A Postoperative Systemic Inflammation Score Predicts Short- and Long-Term Outcomes in Patients Undergoing Surgery for Colorectal Cancer. Ann Surg Oncol. 2017 Apr;24(4):1100-1109.
- Ma M, Weng M, Chen F, Hu Y, Lai J, Wang Y, Zhou Y. Systemic inflammation score is a prognostic marker after curative resection in gastric cancer. ANZ J Surg. 2019 Apr;89(4):377-382.