The Impact of Lung Cancer Resection Surgery on Fibrinogen and C-reactive Protein and Their Relationship with Patients Outcomes: A Prospective Follow Up Study

Objective: To assess the pre and postoperative systemic inflammatory markers of patients undergoing lung cancer resection (LR). Methods: Prospective study conducted with 48 patients submitted to LR. The patients were assessed before and 1 month after surgery through of fibrinogen, C-reative protein (CRP), pulmonary function tests, 6- minute Walk Test (6MWT), maximal inspiratory and expiratory pressure (PImax and PEmax), anxiety and depression scale and karnofsky performance status scale. Results: Fibrinogen and CRP were higher 1 month after surgery, only the CRP was statistically significant (p = 0.03). The 6MWT, PImax, PEmax, FEV1(%) and FVC(%) decreased after surgery with p= 0.001. Anxiety and depression improved and Karnofsky decrease after surgery (p = 0.03, p = 0.01, p = 0.02; respectively). Change in CRP score following LR correlated significantly with changes in fibrinogen (r = 0.40; p = 0.003), change in Karnofsky scale (r = −0.50; p < 0.001) and a borderline significant trend with the 6MWT (r = −0.28; p = 0.05). With the exception of video-assisted thoracoscopic surgery (VATS), who had a significantly lower fibrinogen level 1 month after surgery compared with thoracotomy (p = 0.01), no significant differences in fibrinogen or CRP were noted in other subgroups of patients considered at increased risk for higher levels of inflammation compared with lower risk counterparts. Conclusion: LR was associated with increased level of CRP, 1 month after surgery, and correlated directly with change in fibrinogen and inversely with measurement of performance status. VATS provided lower level of fibrinogen after surgery.