Background Different video-assisted thoracic surgery (VATS) approaches can be adopted to perform lobectomy for non-small cell lung cancer. Given the hypothetical link existing between postoperative inflammation and long-term outcomes, we compared the dynamics of systemic inflammation markers after VATS lobectomy performed with uniportal access (UNIVATS), multiportal access (MVATS), or hybrid approach (minimally invasive hybrid open surgery, MIHOS).

Methods Peripheral blood-derived inflammation markers (neutrophil-to-lymphocyte [NTL] ratio, platelet-to-lymphocyte [PTL] ratio, and systemic immune-inflammation index [SII]) were measured preoperatively and until postoperative day 5 in 109 patients undergoing UNIVATS, MVATS, or MIHOS lobectomy. Differences were compared through repeated-measure analysis of variance, before and after 1:1:1 propensity score matching. Time-to-event analysis was also done by measuring time to NTL normalization, based on the reliability change index for each patient.

Results After UNIVATS, there was a faster decrease in NTL ratio (p = 0.015) and SII (p = 0.019) compared with other approaches. MVATS exhibited more pronounced PTL rebound (p = 0.011). However, all these differences disappeared in matched analysis. After MIHOS, NTL ratio normalization took longer (mean difference: 0.7 ± 0.2 days, p = 0.047), yet MIHOS was not independently associated with slower normalization at Cox's regression analysis (p = 0.255, odds ratio: 1.6, confidence interval: 0.7–4.0). Furthermore, surgical access was not associated with cumulative postoperative morbidity, nor was it with incidence of postoperative pneumonia.

Conclusion In this study, different VATS approaches resulted into unsubstantial differences in postoperative systemic inflammatory response, after adjusting for confounders. The majority of patients returned back to preoperative values by postoperative day 5 independently on the adopted surgical access. Further studies are needed to elaborate whether these small differences may still be relevant to patient management.

背景 技术可以采用不同的电视胸腔镜手术（VATS）方法对非小细胞肺癌进行肺叶切除术。鉴于术后炎症和长期结果之间存在假设的联系，我们比较了采用单通道（UNIVATS）、多通道（MVATS）或混合方法（微创混合开放手术，MIHOS）进行的 VATS 肺叶切除术后全身炎症标志物的动态）。

方法 术前和术后第 5 天测量了 109 例接受手术的患者的外周血炎症标志物（中性粒细胞与淋巴细胞 [NTL] 比率、血小板与淋巴细胞 [PTL] 比率和全身免疫炎症指数 [SII]）。 UNIVATS、MVATS 或 MIHOS 肺叶切除术。在 1:1:1 倾向评分匹配前后，通过重复测量方差分析比较差异。基于每位患者的可靠性变化指数，还通过测量 NTL 标准化的时间来进行事件发生时间分析。

结果 UNIVATS 后， 与其他方法相比， NTL 比率 ( p  = 0.015) 和 SII ( p = 0.019) 下降更快。MVATS 表现出更明显的 PTL 反弹 ( p  = 0.011)。然而，所有这些差异在匹配分析中都消失了。在 MIHOS 之后，NTL 比率标准化需要更长的时间（平均差异：0.7 ± 0.2 天，p  = 0.047），但在 Cox 回归分析中，MIHOS 与较慢的标准化并不独立相关（p  = 0.255，优势比：1.6，置信区间：0.7– 4.0）。此外，手术入路与累积的术后发病率无关，也与术后肺炎的发生率无关。

结论 在本研究中，在调整混杂因素后，不同的 VATS 方法导致术后全身炎症反应的差异不大。大多数患者在术后第 5 天独立于采用的手术通路恢复到术前值。需要进一步的研究来详细说明这些小差异是否仍然与患者管理相关。