Laparoscopic surgery preserves monocyte-mediated tumor cell killing in contrast to the conventional approach.
BACKGROUND
Experimental animal research shows that immunologic defenses against tumor cells are disturbed by surgical trauma, resulting in an increased rate of tumor implantation and the growth of subsequent metastases. Minimally invasive surgery is associated with a preservation of postoperative immunologic functions and, in animal models, with decreased tumor growth. The objective was to study the influence of several surgical procedures, approached conventionally and laparoscopically, on interleukin-6 (IL-6) and monocyte-mediated cytotoxicity (MMC).


METHODS
Five groups of five patients each were included in this prospective study: laparoscopic cholecystectomy (minor trauma) group, Nissen fundoplication (laparoscopic and conventional as moderate trauma) groups, and sigmoid colectomy (laparoscopic and conventional as major trauma) groups. Preoperatively, 1 and 4 days after surgery, IL-6 and MMC against SW948 colon cancer cell line were determined.


RESULTS
The IL-6 levels differed significantly between the three laparoscopic procedures (p = 0.004) and increased according to the degree of trauma. There was no significant difference in MMC between the three laparoscopic procedures. However, MMC was suppressed after conventional procedures and preserved after laparoscopic procedures (p = 0.001). There was no correlation between IL-6 levels and changes in MMC.


CONCLUSIONS
More extensive laparoscopic procedures induce increased levels of IL-6, reflecting higher levels of trauma. Conventional surgical procedures result in depressed MMC in the postoperative period. After laparoscopic procedures, MMC is preserved. These findings may be of importance in preventing implantation and growth of cancer cells spread by surgical manipulation.
Sietses
C
C
Department of Surgery, Academic Hospital, Vrije Universiteit, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands.
Havenith
C E
CE
Eijsbouts
Q A
QA
van Leeuwen
P A
PA
Meijer
S
S
Beelen
R H
RH
Cuesta
M A
MA
D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery; D003602:Cytotoxicity, Immunologic; D005260:Female; D018662:Fundoplication; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology*; D011446:Prospective Studies
D015850:Interleukin-6