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The Scientific World Journal
Volume 2012, Article ID 636754, 5 pages
Clinical Study

Angiogenic Response to Major Lung Resection for Non-Small Cell Lung Cancer with Video-Assisted Thoracic Surgical and Open Access

1Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
2Division of Cardiothoracic Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
3Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong

Received 5 August 2012; Accepted 30 August 2012

Academic Editors: R. Cecere, H. Nakagami, and A. Sihoe

Copyright © 2012 Calvin S. H. Ng et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. Angiogenic factors following oncological surgery is important in tumor recurrence. Vascular endothelial growth factor (VEGF), angiopoietin 1 (Ang-1), Ang-2, soluble VEGF-receptor 1 (sVEGFR1) and sVEGFR2 may influence angiogenesis. This prospective study examined the influence of open and video-assisted thoracic surgery (VATS) lung resections for early stage non-small cell lung cancer (NSCLC) on postoperative circulating angiogenic factors. Methods. Forty-three consecutive patients underwent major lung resection through either VATS ( 𝑛 = 2 3 ) or Open thoracotomy ( 𝑛 = 2 0 ) over an 8-month period. Blood samples were collected preoperatively and postoperatively on days (POD) 1 and 3 for enzyme linked immunosorbent assay determination of angiogenic factors. Results. Patient demographics were comparable. For all patients undergoing major lung resection, postoperative Ang-1 and sVEGFR2 levels were significantly decreased, while Ang-2 and sVEGFR1 levels markedly increased. No significant peri-operative changes in VEGF levels were observed. Compared with open group, VATS had significantly lower plasma levels of VEGF (VATS 1 7 0 ± 9 3  pg/mL; Open 4 8 6 ± 6 4 1  pg/mL; 𝑃 = 0 . 0 4 ) and Ang-2 (VATS 2 4 8 4 ± 1 1 1 9  pg/mL; Open 3 3 7 9 ± 1 2 8 7  pg/mL; 𝑃 = 0 . 0 2 6 ) on POD3. Conclusions. Major lung resection for early stage NSCLC leads to a pro-angiogenic status, with increased Ang-2 and decreased Ang-1 productions. VATS is associated with an attenuated angiogenic response with lower circulating VEGF and Ang-2 levels compared with open. Such differences in angiogenic factors may be important in lung cancer biology and recurrence following surgery.