Systemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial.
OBJECTIVE
This study was designed to evaluate differences in both the peritoneal and systemic immune response after laparoscopic and conventional surgical approaches.


METHODS
Patients with a primary carcinoma were prospectively randomized to curative laparoscopic (n = 12) or conventional (n = 14) colon resection. The proinflammatory cytokines interleukin-6, interleukin-8, and tumor necrosis factor-alpha were measured in the peritoneal drain fluid and in the serum. C-reactive protein and leukocyte counts and the differences in leukocyte subpopulations and expression of human leukocyte antigen-DR on monocytes were measured perioperatively.


RESULTS
Significantly higher levels of proinflammatory cytokine were found in the peritoneal drain fluid than in the circulation after both procedures. Serum interleukin-6 and interleukin-8 levels were significantly lower 2 hours after laparoscopic surgery than with the conventional procedure. Postoperative cellular immune counts and human leukocyte antigen-DR expression normalized earlier after the laparoscopic approach.


CONCLUSIONS
The systemic proinflammatory concentrations after both surgical approaches represent only a small fragment of what is generated in the peritoneal drain fluid. Even if the immediate levels of proinflammatory cytokines in the serum are significantly lower in the laparoscopic group, the same cytokines locally produced showed no differences, which suggests that the two intra-abdominal approaches are equally traumatic. No differences in cellular response were observed between the groups.
Wu
F P K
FP
Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
Sietses
C
C
von Blomberg
B M E
BM
van Leeuwen
P A M
PA
Meijer
S
S
Cuesta
M A
MA
D000368:Aged; D000911:Antibodies, Monoclonal; D001202:Ascitic Fluid / Q000276:immunology*; D002097:C-Reactive Protein / Q000378:metabolism; D016516:CD4-CD8 Ratio; D002277:Carcinoma / Q000276:immunology / Q000601:surgery*; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D015179:Colorectal Neoplasms / Q000276:immunology / Q000601:surgery*; D016207:Cytokines / Q000378:metabolism; D005260:Female; D006684:HLA-DR Antigens / Q000032:analysis; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D016209:Interleukin-8 / Q000378:metabolism; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods; D008297:Male; D009000:Monocytes / Q000276:immunology; D010537:Peritoneum / Q000276:immunology; D010538:Peritonitis / Q000209:etiology / Q000276:immunology*; D011446:Prospective Studies; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis
D000911:Antibodies, Monoclonal; D016207:Cytokines; D006684:HLA-DR Antigens; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein