The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer: a randomized trial

Abstract

PurposeThis study evaluated differences in stress response and immunological function following laparoscopic and conventional total mesorectal excision (TME) for rectal cancer.MethodsPatients with non-metastasized rectal cancer were prospectively randomized to open (n = 18) or laparoscopic (n = 22) TME. Blood samples were taken preoperatively (baseline), 2, 24, and 72 h following surgery. Systemic white blood cell and monocyte count, C-reactive protein, interleukin-6 (IL-6), interleukin-8 (IL-8), HLA-DR expression on monocytes, growth hormone, prolactin, and cortisol were measured.ResultsForty patients with a median age of 66 years (interquartile range, 60–74 years) were included. Eighteen patients (45%) were randomized to open surgery and 22 patients (55%) to laparoscopic surgery. Patient demographics in terms of gender, age, BMI, ASA classification, localization of the tumor, and type of neoadjuvant therapy were comparable for both groups. Laparoscopic surgery resulted in a significantly better short-term preservation of postoperative immune function. HLA-DR expression on monocytes was significantly higher (64% vs 50%, P = 0.014) and IL-6 level increase was significantly lower (4.6 vs 10.8, P = 0.003) 2 h after laparoscopic surgery. No differences between the open and laparoscopic technique were observed in postoperative white blood cell count, monocyte count, C-reactive protein, IL-8, growth hormone, prolactin, and cortisol levels.ConclusionShort-term postoperative immune and inflammatory functions tended to be better after laparoscopic rectal surgery. However, the differences were not consistent at all time intervals, making a definitive conclusion difficult. Better preserved inflammatory function 2 h after surgery may reflect a reduction in operative trauma when the laparoscopic technique is compared with open rectal procedures.

Systemic inflammation and immune response after laparotomyvslaparoscopy in patients with acute cholecystitis, complicated by peritonitis

“…This difference was found in cytokine and cell-mediated immune responses not only in animal experiments but also in clinical trials [21,22] . In our study, while leukocyte counts recovered on day 2 in the laparoscopic group, they did not recover after laparotomy.…”

Surgical Stress Response After Colorectal Resection

“…3,4 Also, cellular immune responses appear to be less affected by laparoscopic colorectal resection compared with open resection as determined by total lymphocyte count, CD4 þ and CD8 þ T cells, interferon-c, and human leukocyte antigen-DR. [5][6][7][8] However, these differences are not consistent at all time intervals, and further studies are needed to fully characterize the importance of temporal changes in these markers. Furthermore, despite potential benefits, laparoscopic surgery still remains technically challenging in rectal cancer and will not be suitable for all patients.…”

Spillage of bacterial products during colon surgery increases the risk of liver metastases development in a rat colon carcinoma model.

“…Previous studies also demonstrated a decrease in MHCII expression after surgery. 44, 45 Furthermore, an increase in levels of IL-6, CRP and D-lactate was reported. 44–50 In all of these studies patient blood samples were collected several hours to days after closure of the abdominal cavity.…”

“…This may be due to delayed release of CRP after post-operative day 1, as demonstrated by previous studies. 45-50 The small number of patients is a limiting factor of the study, and it would be interesting to investigate more patients and/or time points after surgery.…”