Inflammatory response after laparoscopic and conventional colorectal resections - results of a prospective randomized trial.
BACKGROUND
Short-term benefits of laparoscopic relative to conventional colorectal resections have been demonstrated in randomized controlled trials. It has been suggested that a diminished cytokine and acute-phase response may be responsible for these advantages.


METHODS
In a randomized controlled trial, patients underwent laparoscopic (n=30) or conventional (n=30) resection of colorectal tumors. Plasma levels of interleukin-1 receptor antagonist (IL-1RA), interleukin-6 (IL-6), interleukin-10 (IL-10), and C-reactive protein (CRP) were analyzed repeatedly. Postoperative peak levels and area under the curve values were calculated and compared between groups using the Mann-Whitney U-test.


RESULTS
Patient characteristics, preoperative cytokine, and CRP plasma levels were not different between each group. Postoperative peak concentrations of IL-6 (P=0.05) and CRP (P<0.001) and the overall postoperative plasma concentrations of IL-6 (P=0.03) and CRP (P=0.002) were lower in the laparoscopic than in the conventional group. Peak and overall IL-1RA (P=0.2; P=0.2) and IL-10 (P=0.4; P=0. 6) plasma concentrations, respectively, were not different between groups.


CONCLUSIONS
IL-6 and CRP plasma levels were lower after laparoscopic than conventional colorectal resections. The less intense inflammatory response may be an indicator of the milder surgical trauma inflicted by laparoscopic than conventional colorectal resection.
Schwenk
W
W
Department of General, Visceral, Vascular and Thoracic Surgery, Benjamin Franklin Medical School, Medizinische Fakultät der Humboldt-Universität zu Berlin, Charité, Schumannstr. 20/21, D-10117l Berlin, Germany, schwenk@charite.de
Jacobi
C
C
Mansmann
U
U
Böhm
B
B
Müller
J M
JM
D000210:Acute-Phase Reaction / Q000097:blood*; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D003082:Colectomy / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000276:immunology* / Q000601:surgery*; D016207:Cytokines / Q000097:blood*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein; D016753:Interleukin-10 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery*; D012795:Sialoglycoproteins / Q000097:blood; D016896:Treatment Outcome
D016207:Cytokines; C507763:IL1RN protein, human; D053590:Interleukin 1 Receptor Antagonist Protein; D015850:Interleukin-6; D012795:Sialoglycoproteins; D016753:Interleukin-10; D002097:C-Reactive Protein