The Effects of Different Surgical Approaches on the Perioperative Level of Circulating Tumor Cells in Patients with Non-Small Cell Lung Cancer

BackgroundTo observe and compare the effects of video-assisted thoracoscopic surgery (VATS) and conventional thoracotomy on the levels of circulating tumor cells (CTCs) in patients with non-small cell lung carcinoma (NSCLC). MethodsSeventy-nine patients with a diagnosis of NSCLC were enrolled in the study. Forty-three were treated with VATS and 36 were treated with conventional thoracotomy. Blood samples were collected 3 days prior to surgery (d-3), during surgery (d0), and 3 days after surgery (d3). After epithelial cell adhesion molecule (EpCAM)-labeled immunomagnetic cell enrichment, anti-CK-PE and anti-CD45-FITC fluorescent-labeled monoclonal antibodies were added to sort CTCs. Quantification of CTCs was performed using multiparameter flow cytometry. ResultsThe number of CTCs on d0 was significantly higher than on d-3 (5.7304.266 vs. 4.142 +/- 3.971, p=0.033) in both groups. There was no significant difference in the change of CTCs from before surgery to during surgery in the VATS and conventional thoracotomy (open) groups (1.363 +/- 2.924 vs. 1.500 +/- 2.315, p=0.329). However, the increase in number of CTCs from before surgery to after surgery was significantly lower in the VATS group than in the conventional thoracotomy (open) group (2.181 +/- 2.962 vs. 9.666 +/- 15.641, p=0.015). Thirty of the 79 patients tested positive for CTCs before surgery (37.97%). All benign lung disease patients and volunteers tested negative for CTCs. ConclusionA smaller increase in CTCs was seen in patients treated with VATS lobectomy than in patients treated with conventional thoracotomy. This reduction in number of postoperative CTCs may improve long-term survival.