Is Minimal Access Surgery for Cancer Associated with Immunologic Benefits?

Abstract

Minimal-access surgical techniques have been shown to be beneficial to patients in terms of shorter convalescence, reduced pain, and improved cosmesis. Although systemic immune function is better preserved following laparoscopic procedures when compared with their respective open approaches, CO2 pneumoperitoneum may significantly affect local (i.e., infra-abdominal) cellular immunity by reducing regional macrophage function. Results to date are conflicting with regard to the impact of closed and open methods on intraabdominal immunity. Impaired cellular immunity after CO2 pneumoperitoneum may have significant undesirable intra-abdominal effects on tumor surveillance after oncological surgery; however, at present, there is no clinical evidence to support this position. The VATS techniques avoid the use of CO2 insufflation, which may offer some advantages from the immune function perspective over laparoscopic procedures accomplished with CO2 pneumoperitoneum. Better preservation of early postoperative cellular immune function and attenuated disturbance in the inflammatory mediators are likely contributing factors to the clinical benefits that follow laparoscopic surgery and VATS. Larger multi-center randomized trials are needed to confirm the potential benefits of minimal-access surgery on patient survival after cancer surgery. Future research should focus on the effects of minimal-access surgery on other mediators (such as MMP-9, IGFBP-3, IL-12, IL-17, and IL-23) that may be important in tumor cell dissemination, deposition, and propagation in the early postoperative period. Furthermore, additional searches for other factors or mediators, heretofore unrecognized, should be carried out. Such studies will, we hope, increase our knowledge and understanding of the impact of surgery on immune and other physiologic functions.

Perioperative Systemic Inflammatory Response following Robot-Assisted Laparoscopic Cystectomy vs. Open Mini-Laparotomy Cystectomy: A Prospective Study

“…After minor surgical procedures, the vast majority of studies have reported lower postoperative IL-6 and CRP when compared to open procedures [24]. Results from studies comparing SIR and acute phase response in laparoscopy vs. open after major surgery are ambiguous [3,24,25]. A possible reason for this is that the difference in tissue trauma between laparoscopic and open surgery may not be as pronounced after major surgical procedures.…”

“…A key function of IL-6 is the mediation of acute phase response, reflected by the rapid rise in IL-6 and CRP levels in the early postoperative period. After minor surgical procedures, the vast majority of studies have reported lower postoperative IL-6 and CRP when compared to open procedures [24]. Results from studies comparing SIR and acute phase response in laparoscopy vs. open after major surgery are ambiguous [3,24,25].…”

Laparoscopic Surgery For Colon Cancer - A Favorite Method? A Review of Literature

“…The thesis is well documented in multiple studies comparing postoperative increase of acute phase response factors like CRP, IL-1, IL-6, TNF-= after conventional and laparoscopic colon resection (14,27). Laparoscopic surgery is associated with minimal manipulations of the tumor.…”

“…Minimizing the operative trauma leads to less immune supression, less impairment of plasma proteins and less stimulation of neoangiogenesis (6,7,9,14,19,20,21,26,27,28). These phenomenons, dependently of extensiveness of surgical procedure may contribute to unintended tumor growth and survival of cancer cells in the operative field, blood stream and distant organs.…”

“…Experimental studies prove, that operative trauma leads to tumor growth stimulation in the postoperative period (6,9,(19)(20)(21)(22)(23)28). Postoperative immunosupression consists of: decrease of total lymphocyte count, decrease of Th-1 lymphocytes, decrease of cytotoxic lymphocytes, inhibition of lymphocytes proliferation, suppression of NK cells, impaired monocyte human leukocyte antigen expression and suppression of delayed type hypersensivity response (7,9,27,28).…”