Comparative evaluation of surgical stress of laparoscopic and open surgeries for colorectal carcinoma.
OBJECTIVE
To objectively evaluate the benefits of laparoscopic procedures for colorectal carcinoma, a prospective study to measure the stress response to laparoscopic surgery (n = 15) compared with open surgery (n = 12) was undertaken. In addition, to compare the various parameters relevant to surgical stress, the major surgery group (transthoracic esophagectomy for esophageal carcinoma, n = 4; and left upper abdominal evisceration for gastric carcinoma, n = 3) was assigned.


METHODS
Peripheral blood samples were obtained to measure serum interleukin-6, C-reactive protein, peripheral leukocytes, and lymphocyte counts. Additionally, the level of lymphocyte apoptosis was quantified using flow cytometry.


RESULTS
The interleukin-6 and C-reactive protein levels were significantly greater in the open group than in the laparoscopy group one day (P < 0.05) and two days (P < 0.05) after surgery, respectively. In the laparoscopy group, lymphocyte counts were significantly higher than in the open group two days after surgery. The laparoscopy and open groups did not differ significantly in their lymphocyte apoptotic index. In the major surgery group, the apoptotic index was significantly higher than in either the laparoscopy group or the open group in the early postoperative period.


CONCLUSIONS
Changes in the various parameters pertinent to surgical stress evaluated in this study suggest that laparoscopic surgery for colorectal carcinoma leads to less postoperative stress than conventional open surgery.
Department of General and Gastroenterological Surgery, Osaka Medical College, Japan.
K
K
Nishiguchi
J
J
Okuda
M
M
Toyoda
K
K
Tanaka
N
N
Tanigawa
D000368:Aged; D016063:Blood Loss, Surgical; D002097:C-Reactive Protein / Q000032:analysis; D015179:Colorectal Neoplasms / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004938:Esophageal Neoplasms / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D007902:Length of Stay; D007958:Leukocyte Count; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000503:physiopathology / Q000601:surgery; D013312:Stress, Physiological / Q000503:physiopathology*
D015850:Interleukin-6; D002097:C-Reactive Protein