P1.08-008 Impact of Perioperative Redox Balance on Long-Term Outcome in Patients Undergoing Lung Resection

Abstract

Surgical stress provokes a cytokine storm and systemic inflammatory response syndrome, and can also affect redox balance during the postoperative course. However, whether inflammatory status, especially redox balance, during the perioperative period has effects on long-term outcome following surgery for lung cancer remains unclear. The aim of this study was to determine whether redox balance during the perioperative period is associated with long-term survival of patients after undergoing lung resection. Consecutive patients who underwent an anatomical lung resection greater than a segmentectomy for non-small cell lung cancer from January to June 2013 at our institution were investigated. The Ethical Committee of Dokkyo Medical University Hospital approved this study (#24043) and all participating patients provided informed consent. Serum was collected during the operation, and on post-operative day (POD) 3 and 7, and the levels of reactive oxygen metabolites (d-ROM) and biological antioxidant potential (BAP) were measured using FREE carpe diem (Wismerll). We analyzed overall survival, relapse, and cause of death. Twenty-two patients (males 18, females; 69±7 years old) were enrolled, of whom 12 underwent open surgery and 6 VATS. Histology findings showed 12 adenocarcinomas, 6 squamous cell carcinomas, and 4 others. Comorbidities in the patients were chronic obstructive pulmonary disease in 8 and idiopathic pulmonary fibrosis in 5. d-ROM values on POD 3 and 7 were significantly increased as compared to those obtained during the operation (perioperative 288±65, POD 3 439±49, POD 7 479±49; p<0.001), whereas BAP did not change after surgery. Overall survival was 71.4% after 3 years. A receiver operating characteristic curve revealed a dROM cut-off value of 327 during the operation. Patients with a dROM value of 327 or less showed significantly superior 3-year survival as compared to those with a greater value (87.5% vs. 20.0%, p<0.001). Surgical stress caused an increase in dROM during the postoperative course. The dROM value obtained during the operation was correlated with long-term survival of patients after undergoing resection for lung cancer.