title: Systemic and peritoneal inflammatory response after laparoscopic or conventional colon resection in cancer patients: a prospective, randomized trial.
abstract: 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.
authors.affiliation: Department of Surgery, VU Medical Center, Amsterdam, The Netherlands.
authors.forename: F P K
authors.initials: FP
authors.lastname: Wu
authors.forename: C
authors.initials: C
authors.lastname: Sietses
authors.forename: B M E
authors.initials: BM
authors.lastname: von Blomberg
authors.forename: P A M
authors.initials: PA
authors.lastname: van Leeuwen
authors.forename: S
authors.initials: S
authors.lastname: Meijer
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
mesh_terms: 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
chemical_list: D000911:Antibodies, Monoclonal; D016207:Cytokines; D006684:HLA-DR Antigens; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D002097:C-Reactive Protein