Abstract
PURPOSE: This study was designed to evaluate differences in both the peritoneal and systemic immune response after laparoscopic and conventional surgical approaches. METHODS: Patients with a primary carcinoma were prospectively randomized to curative laparoscopic (n = 12) or conventional (n = 14) colon resection. The proinflammatory cytokines interleukin-6, interleukin-8, and tumor necrosis factor-alpha were measured in the peritoneal drain fluid and in the serum. C-reactive protein and leukocyte counts and the differences in leukocyte subpopulations and expression of human leukocyte antigen-DR on monocytes were measured perioperatively. RESULTS: Significantly higher levels of proinflammatory cytokine were found in the peritoneal drain fluid than in the circulation after both procedures. Serum interleukin-6 and interleukin-8 levels were significantly lower 2 hours after laparoscopic surgery than with the conventional procedure. Postoperative cellular immune counts and human leukocyte antigen-DR expression normalized earlier after the laparoscopic approach. CONCLUSIONS: The systemic proinflammatory concentrations after both surgical approaches represent only a small fragment of what is generated in the peritoneal drain fluid. Even if the immediate levels of proinflammatory cytokines in the serum are significantly lower in the laparoscopic group, the same cytokines locally produced showed no differences, which suggests that the two intra-abdominal approaches are equally traumatic. No differences in cellular response were observed between the groups.
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References
JD Allendorf M Bessler RL Whelan et al. (1997) ArticleTitlePostoperative immune function varies inversely with the degree of surgical trauma in a murine model Surg Endosc 11 427–430
JD Allendorf M Bessler KD Horvath MR Marvin DA Laird RL Whelan (1999) ArticleTitleIncreased tumor establishment and growth after open vs laparoscopic surgery in mice may be related to differences in postoperative T-cell function Surg Endosc 13 233–235
TW Lennard BK Shenton A Borzotta et al. (1985) ArticleTitleThe influence of surgical operations on components of the human immune system Br J Surg 72 771–776
AJ Karayiannakis GG Makri A Mantzioka D Karousos G Karatzas (1997) ArticleTitleSystemic stress response after laparoscopic or open cholecystectomy Br J Surg 84 467–471
RM Roumen PA van Meurs HH Kuypers WA Kraak RW Sauerwein (1992) ArticleTitleSerum interleukin-6 and C reactive protein responses in patients after laparoscopic or conventional cholecystectomy Eur J Surg 158 541–544
C Sietses MJ Wiezer QA Eijsbouts et al. (1999) ArticleTitleA prospective randomized study of the systemic immune response after laparoscopic and conventional Nissen fundoplication Surgery 126 5–9
PM Hewitt SM Ip SP Kwok et al. (1998) ArticleTitleLaparoscopic-assisted vs. open surgery for colorectal cancer Dis Colon Rectum 41 901–909
E Santoro M Carlini F Carboni A Feroce (1999) ArticleTitleColorectal carcinoma: laparoscopic versus traditional open surgery. A clinical trial Hepatogastroenterology 46 900–904
W Schwenk C Jacobi U Mansmann B Bohm JM Muller (2000) ArticleTitleInflammatory response after laparoscopic and conventional colorectal resections—results of a prospective randomized trial Langenbecks Arch Surg 385 2–9
J Ordemann CA Jacobi W Schwenk . Stösslein JM Müller (2001) ArticleTitleCellular and humoral inflammatory response after laparoscopic and conventional colorectal resections. Results of a prospective randomized trial Surg Endosc 15 600–608
JG Stage S Schulze P Moller et al. (1997) ArticleTitleProspective randomized study of laparoscopic versus open colonic resection for adenocarcinoma Br J Surg 84 391–396
KL Leung PB Lai RL Ho et al. (2000) ArticleTitleSystemic cytokine response after laparoscopic-assisted resection of rectosigmoid carcinoma Ann Surg 231 506–511
E Lin SE Calvano SF Lowry (2000) ArticleTitleInflammatory cytokines and cell response in surgery Surgery 127 117–126
RB Johnston (1988) ArticleTitleCurrent concepts: immunology. Monocytes and macrophages N Engl J Med 318 747–752
J Psaila SH Bulley P Ewings JP Sheffield RH Kennedy (1998) ArticleTitleOutcome following laparoscopic resection for colorectal cancer Br J Surg 85 662–664
AM Lacy JC Garcia-Valdecasas JM Pique et al. (1995) ArticleTitleShort-term outcome analysis of a randomized study comparing laparoscopic vs open colectomy for colon cancer Surg Endosc 9 1101–1105
S Delgado AM Lacy X Filella et al. (2001) ArticleTitleAcute phase response in laparoscopic and open colectomy in colon cancer Dis Colon Rectum 44 638–646
C Gabay I Kushner (1999) ArticleTitleAcute-phase proteins and other systemic responses to inflammation N Engl J Med 340 448–454
T Kondo T Ohshima (1996) ArticleTitleThe dynamics of inflammatory cytokines in the healing process of mouse skin wound Int J Legal Med 108 231–236
P Kinnaert JP De Wilde B Bournonville C Husson I Salmon (1996) ArticleTitleDirect activation of human peritoneal mesothelial cells by heat-killed microorganisms Ann Surg 224 749–754
KA Heel JC Hall (1996) ArticleTitlePeritoneal defences and peritoneum-associated lymphoid tissue Br J Surg 83 1031–1036
A Tokunaga M Onda I Fujita et al. (1993) ArticleTitleSequential changes in the cell mediators of peritoneal and wound fluids after surgery Surg Today 23 841–844
H Wiik R Karttunen K Haukipuro H Syrjala (2001) ArticleTitleMaximal local and minimal systemic cytokine response to colorectal surgery Cytokine 14 188–192
KJ Van Zee T Kohno E Fischer CS Rock LL Moldawer SF Lowry (1992) ArticleTitleTumor necrosis factor soluble receptors circulate during experimental and clinical inflammation and can protect against excessive tumor necrosis factor alpha in vitro and in vivo Proc Natl Acad Sci U S A 89 4845–4849
C Sietses CE Havenith QA Eijsbouts et al. (2000) ArticleTitleLaparoscopic surgery preserves monocyte mediated tumor cell killing in contrast to the conventional approach Surg Endosc 14 456–460
TJ Schall K Bacon KJ Toy DV Goeddel (1990) ArticleTitleSelective attraction of monocytes and T lymphocytes of the memory phenotype by cytokine RANTES Nature 347 669–671
AE Koch PJ Polverini SL Kunkel et al. (1992) ArticleTitleInterleukin-8 as a macrophage-derived mediator of angiogenesis Science 258 1798–1801
HO Rennekampff JF Hansbrough V Kiessig C Dore M Sticherling JM Schroder (2000) ArticleTitleBioactive interleukin-8 is expressed in wounds and enhances wound healing J Surg Res 93 41–54
M Schein DH Wittmann R Holzheimer RE Condon (1996) ArticleTitleHypothesis Surgery 119 694–700
M Sticherling F Hetzel JM Schroder E Christophers (1993) ArticleTitleTime- and stimulus-dependent secretion of NAP-1/IL-8 by human fibroblasts and endothelial cells J Invest Dermatol 101 573–576
DM Steel AS Whitehead (1994) ArticleTitleThe major acute phase reactants Immunol Today 15 81–88
D Decker M Schondorf F Bidlingmaier A Hirner AA von Ruecker (1996) ArticleTitleSurgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down-regulation of cell-mediated and up-regulation of antibody-mediated immunity commensurate to the trauma Surgery 119 316–325
CH Wakefield PD Carey S Foulds JR Monson PJ Guillou (1993) ArticleTitleChanges in major histocompatibility complex class II expression in monocytes and T cells of patients developing infection after surgery Br J Surg 80 205–209
WG Cheadle MJ Hershman SR Wellhausen HC Polk SuffixJr (1991) ArticleTitleHLA-DR antigen expression on peripheral blood monocytes correlates with surgical infection Am J Surg 161 639–645
T Kloosterman BM von Blomberg P Borgstein MA Cuesta RJ Scheper S Meijer (1994) ArticleTitleUnimpaired immune functions after laparoscopic cholecystectomy Surgery 115 424–428
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Wu, F.P., Sietses, C., von Blomberg, B.M. et al. Systemic and Peritoneal Inflammatory Response After Laparoscopic or Conventional Colon Resection in Cancer Patients. Dis Colon Rectum 46, 147–155 (2003). https://doi.org/10.1007/s10350-004-6516-2
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DOI: https://doi.org/10.1007/s10350-004-6516-2