Laparoscopic-assisted vs. open surgery for colorectal cancer : Comparative study of immune effects

• Published in: Diseases of the colon & rectum Vol. 41; no. 7; pp. 901 - 909
• Main Authors: HEWITT, P. M, KWOK, S. P. Y, SOMERS, S. S, LI, K, LEUNG, K. L, LAU, W. Y, LI, A. K. C
• Format: Conference Proceeding Journal Article
• Language: English
• Published: Secaucus, NJ Springer 01.07.1998
• Subjects: Adult; Aged; Biological and medical sciences; Colectomy - methods; Colorectal Neoplasms - surgery; Female; Granulocytes; Humans; Immunity, Cellular; Interleukin-6 - blood; Killer Cells, Natural; Laparoscopy; Lymphocyte Subsets; Male; Medical sciences; Middle Aged; Prospective Studies; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tropical medicine; Human; Rectal disease; Carcinoma; Immune response; Cytokine; Surgical resection; Laparoscopy; Malignant tumor; Colonic disease; Interleukin 6; Surgery; Rectum; Digestive diseases; Intestinal disease; Surgical approach; Endoscopy; Colon; Biological effect; Laparotomy; Lymphocyte; Comparative study
• ISSN: 0012-3706; 1530-0358
• DOI: 10.1007/BF02235376

Our aim was to test the hypothesis that laparoscopic-assisted resection for colorectal cancer has an immunologic advantage over traditional open surgery. Sixteen patients with colorectal cancer were randomized to undergo laparoscopic-assisted resection or open surgery. Basic patient data were recorded, and serum interleukin-6 levels, relative proportions of lymphocytes, and human leukocyte antigen-DR expression on monocytes were determined at specific time intervals. Operating time was longer for laparoscopic-assisted resection (P=0.02), but analgesic requirements were less (P=0.04). All patients exhibited the following: interleukin-6 levels increased to a maximum at 4 hours and returned to preoperative levels within 48 hours. This response appeared greater for open resection (mean peak level, 313 vs. 173 pg/ml; P=0.25). Relative granulocytosis (P < 0.001) was seen within 48 hours, which was offset by a decrease in percentage of lymphocytes (P < 0.001). Changes in lymphocyte subfractions were most significant seven days postsurgery: natural killer cells decreased (P=0.003); T cells increased (P=0.008), with elevation in the CD4/CD8 ratio (P=0.003). B cells were largely unchanged at all time periods. Human leukocyte antigen-DR expression on monocytes was significantly less at 48 hours postsurgery (P < 0.001). All changes were reversed within three weeks of surgery. There were no differences when comparing laparoscopic-assisted resection with open surgery. Both laparoscopic-assisted resection and open surgery affect the immune response. It would appear that laparoscopic-assisted resection does not have an immunologic advantage over open surgery in patients with colorectal cancer.