title: Prospective comparison of the immunological and stress response following laparoscopic and open surgery for localized renal cell carcinoma.
abstract: 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.
authors.affiliation: Division of Urology, Washington University School of Medicine, St Louis, Missouri, USA.
authors.forename: Jaime
authors.initials: J
authors.lastname: Landman
authors.forename: Ephrem
authors.initials: E
authors.lastname: Olweny
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
authors.forename: Cathy
authors.initials: C
authors.lastname: Chen
authors.forename: Jamil
authors.initials: J
authors.lastname: Rehman
authors.forename: David I
authors.initials: DI
authors.lastname: Lee
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalhav
authors.forename: Andrew
authors.initials: A
authors.lastname: Portis
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: 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*