Objectives: We evaluated differences in cytokine responses and T-lymphocyte subsets following retroperitoneal laparoscopic and conventional open radical nephrectomies for localized renal cell carcinoma (RCC). Methods: A total of 62 patients with T 1 N 0 M 0 staged RCC were randomized to either retro-laparoscopic (n = 31) or open (n = 31) radical nephrectomy. Plasma levels of interleukin-1β (IL-1β), IL-6, and tumour necrosis factor-alpha (TNF-α) were measured separately by enzyme linked immunosorbent assay (ELISA) preoperatively and on postoperative days 1 and 5. Levels + in the open group, returned to about preoperative levels (p < 0.05). Follow-up ranged from 4 to 14 months postoperatively in all 62 patients with a 100% cancerspecific survival rate in both groups. Conclusions: Retroperitoneal laparoscopic radical nephrectomy is associated with the milder cytokine responses caused by trauma and inflammation and the better preserved distribution of T-lymphocytes.
IntroductionSince Clayman and colleagues in 1991 1 reported the first laparoscopic radical nephrectomy (LRN) for a tumour-bearing kidney, this technique has become increasingly popular because of milder postoperative pain, decreased hospital stay and shortened convalescence compared to the conventional open radical nephrectomy (ORN). During the last 20 years, with advances in instrumentation and surgeon experience, LRN has emerged as an equally effective and minimally morbid surgical alternative to ORN for selected kidney neoplasms.
2,3Surgical trauma provokes a variety of physiologic and immunologic changes in the host. The host's acute phase response to injury includes a complicated interaction among the metabolic, neuroendocrine and immune systems. This response is deemed to be proportional to the extent of the initial injury and is presumably directed toward the host defense. 4 Due to this altered immune response in the postoperative period, surgical trauma can cause an increased production of pro-inflammatory cytokines and an inhibition of cellular responses.5 A wealth of studies with intermediate to long-term follow-up results indicate that laparoscopic radical malignance resections offer equivalent safety and oncologic efficacy as compared to open surgical approaches.6,7 This is partially because of the reduced inflammatory response and minimal extent of immunosuppression. However, some authors have reported no evidence of improved immunity after laparoscopy. [8][9][10][11] In addition, port site metastases (PSM) and local recurrences, although occasionally observed, remain a disputable problem with laparoscopic surgery for cancer. 12,13 With respect to renal cell carcinoma (RCC), laparoscopy related studies on the host immunity are insufficient and incomplete. Whether and how the laparoscopy under CO 2 pneumoperitoneum could exert some negative influences on the RCC patients is still unclear.