Laparoscopic-assisted vs. open surgery for colorectal cancer: comparative study of immune effects.
OBJECTIVE
Our aim was to test the hypothesis that laparoscopic-assisted resection for colorectal cancer has an immunologic advantage over traditional open surgery.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Hewitt
P M
PM
Department of Surgery, Prince of Wales Hospital and Chinese University Hong Kong, Shatin, New Territories.
Ip
S M
SM
Kwok
S P
SP
Somers
S S
SS
Li
K
K
Leung
K L
KL
Lau
W Y
WY
Li
A K
AK
D000328:Adult; D000368:Aged; D003082:Colectomy / Q000379:methods*; D015179:Colorectal Neoplasms / Q000601:surgery*; D005260:Female; D006098:Granulocytes; D006801:Humans; D007111:Immunity, Cellular; D015850:Interleukin-6 / Q000097:blood; D007694:Killer Cells, Natural; D010535:Laparoscopy; D016131:Lymphocyte Subsets; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D015850:Interleukin-6