Abstract
Background
Laparoscopic liver surgery is a field in its infancy, and scientific evidence of its benefits over those of traditional open techniques has not been shown. Various applications from wedge resections to formal segmental resections have been reported, but the technical ability does not necessarily translate into improved patient outcomes. There is an abundance of evidence reflecting the benefits of laparoscopic cholecystectomy [9, 12, 23], and some of these benefits have been linked to the decreased metabolic and immune responses involved [24, 27]. There is also accumulating evidence that tumor growth may be slower after laparoscopic surgery than after comparable open surgery, and that this is a result of less immune suppression [1]. It is not known whether laparoscopic liver surgery will convey similar benefits.
Methods
In this study, 14 pigs were assigned randomly to undergo a liver resection either by a laparoscopic or an open approach. Operative stress was assessed via cortisol, tumor necrosis factor, interleukin-6, C-reactive protein. The immune response was evaluated through delayed-type hypersensitivity skin antigen testing. Adhesion formation also was assessed at 6 weeks.
Results
Immune response as measured by delayed-type hypersensitivity is better preserved after laparoscopic than after open liver resection. The average diameter of induration was 46% greater in the laparoscopic group (20.71±2.7 mm versus 14.14±1.5 mm). Interleukin-6 and tumor necrosis factor levels showed a significantly greater rise after open surgery. No difference was observed in the levels of C-reactive protein or cortisol. Adhesion formation was considerably less after laparoscopic resection.
Conclusions
Laparoscopic liver resection results in a diminished stress response, as compared with that of open resection, which translates into greater preservation of immune function. This finding may well have a beneficial effect on infection and tumor growth.
Similar content being viewed by others
References
Allendorf JD, Bessler M, Kayton ML, Oesterling SD, Treat MR, Nowygrod R, Whelan RL (1995) Increased tumor establishment and growth after laparotomy versus laparoscopy in a murine model. Arch Surg 130: 649–653
Allendorf JDF, Bessler M, Kayton ML, Whelan RL, Treat MR, Nowygrod R (1995) Tumor growth after laparotomy or laparoscopy: a preliminary study. Surg Endosc 9: 49
Bessler M, Treat MR, Halverson A, Nowygrod R, Whelan RL (1994) Laparoscopic colectomy induces a hormonal stress response. Surg Endosc 8: 447
Bessler M, Whelan RL, Halverson A, Treat MR, Nowygrod R (1994) Is immune function better preserved after laparoscopic versus open colon resection? Surg Endosc 8: 881–883
Cho JM, La Porta AJ, Clark JR, Schofield MJ, Hammond SL, Mallory PL II (1994) Response of serum cytokines in patients undergoing laparoscopic cholecystectomy. Surg Endosc 8: 1380–1384
Cruikshank IS, Fraser WD, Burns HJG, Shenkin A (1996) Response of serum IL-6 in patients undergoing elective surgery of varying severity. Clin Sci 79: 161–165
Cuesta MA, Meijer S, Paul A, de Brauw LM (1995) Limited laparoscopic liver resection of benign tumors guided by laparoscopic ultrasonography: report of two cases. Surg Laparosc Endosc 5: 396–401
Cunningham JD, Katz LB, Brower ST, Reiner MA (1995) Laparoscopic resection of two liver hemangiomata. Surg Laparosc Endosc 5: 277–280
Cuschieri A, Dubois F, Mouiel J, Mouret P, Becker H, Buess G, Trede M, Troidl H (1991) The European experience with laparoscopic cholecystectomy. Am J Surg 16: 385
Douglas RE, Johnson MD, Spencer MP (1994) Laparoscopic versus open colectomy: a comparative study of the systemic stress response. Surg Endosc 8: 447
Ferzli G, David A, Kiel T (1995) Laparoscopic resection of a large hepatic tumor. Surg Endosc 9: 733–735
Gadacz TR (1993) U.S. experience with laparoscopic cholecystectomy. Am J Surg 165: 450
Gugenheim J, Mazza D, Kathkouda N, Goubaux B, Muoiel J (1996) Laparoscopic resection of solid liver tumors. Br J Surg 83: 334–335
Alevy A, Lin G, Gold-Deutsch R, Lavi R, Negri M, Vans S, Cotariu D, Sackier JM (1995) A comparison of C-reactive protein concentrations for laparoscopic versus open cholecystectomy. Surg Endosc 9: 280–282
Harmon GD, Senagore AJ, Kilbride MJ, Warzynski MJ (1994) IL-6 response to laparoscopic and open colectomy. Dis Colon Rectum 37: 754–759
Kaneko H, Takagi S, Shiba T (1996) Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery 120: 468–475
Kloosterman T, von Blomberg BM, Borgstein P, Cuesta MA, Scheper RJ, Meijer S (1994) Unimpaired immune functions after laparoscopic cholecystectomy. Surgery 115: 424–428
Maruszynski M, Pojda Z (1995) IL-6 concentrations in patients treated by cholecystectomy via laparotomy or laparoscopy. Surg Endosc 9: 882–885
Perlmutter DH, Dinarello CA, Punsal PI, Coltan HR (1986) Cachectin/tumour necrosis factor regulates hepatic acute phase gene expression. J Clin Invest 78: 1349–1354
Pullicino EA, Carli F, Poole S, Rafferty B, Malik ST, Elia M (1990) The relationship between the circulating concentrations of IL-6, TNF, and the acute phase response to elective surgery and accidental injury. Lymphokine Res 9: 231–238
Rau HG, Meyer G, Cohnert TU, Scardey HM, Jauch K, Schildberg FW (1995) Laparoscopic liver resection with water-jet dissector. Surg Endosc 9: 1009–1012
Samama G, Chiche L, Brefort JL, LeRoux Y (1998) Laparoscopic anatomic hepatic resection. Surg Endosc 12: 76–78
Sawyers JL (1996) Current status of conventional cholecystectomy versus laparoscopic cholecystectony. Ann Surg 223: 1–3
Schauer PR, Sirinek KR (1995) The laparoscopic approach reduces the endocrine response to elective cholecystectomy. Am Surg 61: 106
Stoner HB, Frayn KN (1979) The relationship between plasma substrates and hormones and the severity of injury in 277 recently injured patients. Clin Sci 56: 563
Vaughan GM, Becker RA (1982) Cortisol and corticotrophin in burn patients. J Trauma 22: 263
Vittimberga FJ, Foley DP, Meyers WC, Callery MP (1998) Laparoscopic surgery and the systemic immune response. Ann Surg 227: 326–324
Watanabe Y, Sato M, Ueda S, Abe Y, Iseki S, Horiuchi A, Kashu Y, Kawachi K (1997) Laparoscopic hepatic resection: a new safe procedure by abdominal wall lifting method. Hepato gastroenterology 44: 143–147
Author information
Authors and Affiliations
Additional information
Online publication: 27 February 2002
Rights and permissions
About this article
Cite this article
Burpee, S.E., Kurian, M., Murakame, Y. et al. The metabolic and immune response to laparoscopic vs open liver resection. Surg Endosc 16, 899–904 (2002). https://doi.org/10.1007/s00464-001-8122-x
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00464-001-8122-x