Prospective comparison of the immunological and stress response following laparoscopic and open surgery for localized renal cell carcinoma.
OBJECTIVE
We prospectively compared the systemic immune and stress response of patients who underwent laparoscopic total nephrectomy (LRN) (14) and open nephrectomy (ON) (10) for renal cell carcinoma. The ON group comprised open radical (4), open total (2) and open partial (4) nephrectomy cases.


METHODS
Only patients with no history of cancer or autoimmune disease and American Society of Anesthesiologists score 2 or less who were not using immunosuppressive drugs were selected. Peripheral venous blood was collected preoperatively and intraoperatively, and 24 hours, 2 weeks, 4 weeks and 3 months postoperatively. Blood was analyzed for stress markers (adrenalin, noradrenalin and cortisol), inflammatory response markers (C-reactive protein, white blood count and leukocyte count), lymphocytic response markers (CD3, CD4 and CD8), cytokines interleukin-2 and 4, interferon-alpha and tumor necrosis factor-alpha), HLA-DR expression and the proliferative response to mitogen stimulation using concanavalin A, phytohemagglutinin 10, and pokeweed mitogen.


RESULTS
Mean tumor size +/- SD for ON and LRN was 5.6 +/- 2.4 and 4.5 +/- 1.6 cm, respectively (p = 0.21). The trends with time for all measured postoperative parameters were similar in the 2 groups. Inflammatory and stress response markers were statistically similar for in the groups at all time points. A significant difference between the groups was noted for the percentage of CD4+ and CD8+ lymphocytes. However, this difference was present preoperatively and there was no significant absolute change in these 2 parameters. The cytokine response and HLA-DR expression were similar in the 2 groups at all time points. Likewise, the lymphocytic stimulation index for concanavalin A, phytohemagglutinin and pokeweed mitogen were statistically similar for LRN and ON at all time points.


CONCLUSIONS
The immunological and stress response after LRN and ON for renal cell carcinoma is similar. The few differences observed in measured parameters likely reflect preoperative differences in baseline and/or the contributory effect of anesthesia.
Landman
Jaime
J
Division of Urology, Washington University School of Medicine, St Louis, Missouri, USA.
Olweny
Ephrem
E
Sundaram
Chandru P
CP
Chen
Cathy
C
Rehman
Jamil
J
Lee
David I
DI
Shalhav
Arieh
A
Portis
Andrew
A
McDougall
Elspeth M
EM
Clayman
Ralph V
RV
D002292:Carcinoma, Renal Cell / Q000276:immunology* / Q000601:surgery*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000276:immunology* / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects*; D011446:Prospective Studies; D013312:Stress, Physiological / Q000453:epidemiology / Q000209:etiology*