Study Of Stress Hormone Levels Following Lobectomy Of Video-assisted Thoracoscopic Surgery And Conventional Thoracotomy In Treatment For Non-small Cell Lung Cancer

Objective:Through a prospective control research, we compared the lobectomy of video-assisted thoracoscopic surgery(VATS) and conventional thoracotomy in treatment for non-small cell lung cancer(NSCLC). We observed the changes of the seral stress hormone levels for several days before and after VATS and conventional thoracotomy to judge whether VATS is less traumatic and can better preserves postoperative immune function.Methods:From Oct.2010 to May.2011,27 consecutive patients with NSCLC were recruited and divided into two groups:VATS group (14 patients) and OT group (13 patients). All the patients underwent anatomic lobectomy with systematically mediastinal lymphadenectomy. There were no differences between the two groups with respect to age, gender, pulmonary function, comorbidities, tumor size, and pathology. Plasma levels of cortisol, adrenocorticotropic hormone (ACTH) and growth hormone(GH) were measured on the morning of the day before surgery, the postoperative day(POD) 1, POD 2, POD 3 and POD 7 in all patients. We compared the levels of the stress hormones between the two groups. Meanwhile, we also compared the operating time, bleeding volume, blood transfusion, the number of lymph nodes resected, hospital stay after surgery, and duration of chest drainage of the two groups..Results:VATS group had a significantly less blood transfusion than OT group(P=0.034). There were no differences in the operating time, bleeding volume, the number of lymph nodes resected, hospital stay after surgery, and duration of chest drainage between VATS and OT group (P>0.05). Before surgery there were no differences in the levels of cortisol, growth hormone, ACTH between the two groups. The COR and GH levels were all elevated after surgery, reached the peak concentration at POD 2, and then declined gradually. Cortisol and GH levels were significantly lower in VATS group than OT group on POD2 (P=0.025,0.020). On POD 7, the concentrations of cortisol and GH of VATS group were diminished to nearly the before-surgery level, and there were no differences between them (P>0.05). On POD 7 the cortisol level of OT group was also significantly higher than the before-surgery level (P=0.03). There were no significant differences in ACTH level between the two groups at any time (P>0.05).Conclusion:VATS group had a lower level of cortisol and growth hormone after surgery than OT group. There was a weaker acute stress reaction after VATS lobectomy. VATS is less traumatic and indicates to better preserve the immune function.