Interleukin-6, C-reactive protein, and expression of human leukocyte antigen-DR on peripheral blood mononuclear cells in patients after laparoscopic vs. conventional bowel resection: a randomized study.
OBJECTIVE
The aim of the study was to investigate the effect of surgical trauma in terms of approach (laparoscopic vs. conventional surgery) and extent of bowel resection (ileocolic resection vs. colectomy) on interleukin-6 level, C-reactive protein level, and expression of human leukocyte antigen-DR on peripheral blood mononuclear cells. Second, the length of the incision was correlated with the inflammatory response.


METHODS
Thirty-four patients were analyzed as part of a randomized trial comparing laparoscopically assisted vs. open bowel resection for Crohn's disease, ulcerative colitis, and familial adenomatous polyposis. C-reactive protein levels and expression of human leukocyte antigen-DR on peripheral blood mononuclear cells were measured preoperatively and one day after surgery. Interleukin-6 was measured preoperatively and on Days 1 and 7 postoperatively.


RESULTS
Four of the 34 patients were excluded because of blood transfusion after surgery. One day postoperatively, the interleukin-6 level peaked significantly within the laparoscopic and conventional group. There was no significant difference between the conventional and laparoscopic groups at Day 1 postoperatively. At Day 7 postoperatively, interleukin-6 levels were similar in both groups and returned to baseline levels. There was a higher C-reactive protein level in the conventional group one day after surgery than in the laparoscopic group, although the difference was not significant. Preoperative and postoperative human leukocyte antigen-DR expression on monocytes and postoperative percentage of lymphocytes expressing human leukocyte antigen-DR did not differ between the conventional and laparoscopic groups. No differences in immune response with respect to the measured parameters were noticed in patients with a large or small bowel resection segment or in patients with a small (</=8 cm) or large (>8 cm) incision.


CONCLUSIONS
These data suggest that surgical trauma did not significantly affect the immune status of patients with respect to the measured parameters in terms of either the approach or the extent of bowel resection.
Dunker
M S
MS
Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands.
Ten Hove
T
T
Bemelman
W A
WA
Slors
J F M
JF
Gouma
D J
DJ
Van Deventer
S J H
SJ
D011125:Adenomatous Polyposis Coli / Q000097:blood / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D002097:C-Reactive Protein / Q000032:analysis*; D003082:Colectomy / Q000379:methods*; D003093:Colitis, Ulcerative / Q000097:blood / Q000601:surgery; D003424:Crohn Disease / Q000097:blood / Q000601:surgery; D005260:Female; D005434:Flow Cytometry; D006684:HLA-DR Antigens / Q000097:blood*; D006801:Humans; D007082:Ileum / Q000601:surgery; D015850:Interleukin-6 / Q000097:blood*; D010535:Laparoscopy / Q000379:methods*; D008214:Lymphocytes / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000378:metabolism*; D013997:Time Factors
D015415:Biomarkers; D006684:HLA-DR Antigens; D015850:Interleukin-6; D002097:C-Reactive Protein