Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study.
OBJECTIVE
Laparoscopy has become a popular approach for the surgical treatment of benign and even malignant colorectal diseases. Several authors have reported better preserved immunity in patients undergoing laparoscopic compared with conventional colorectal surgery. The present study addresses the hypothesis that specific and nonspecific immunity are differently affected by laparoscopic and conventional colorectal surgery.


METHODS
Nonrandomized control trial.


METHODS
University hospital.


METHODS
Seventy prospectively enrolled patients with colorectal diseases undergoing laparoscopic (n = 35) or open (n = 35) surgery.


METHODS
Blood samples were taken prior to surgery as well as on days 1, 3, and 5 after surgery. Cell numbers of lymphocyte subpopulations as well as natural killer cells were determined by flow cytometry, and interleukin 6 and C-reactive protein serum levels were measured.


RESULTS
Significant differences between study and control patients (P<.05) were detected regarding circulating interleukin 6 and C-reactive protein levels with a reduced proinflammatory response to surgery in patients after laparoscopic surgery. Furthermore, postoperative natural killer cell counts were significantly higher in patients after laparoscopic surgery. The levels of B lymphocytes and T lymphocytes and helper T-cell counts and cytotoxic (suppressor) T-cell counts did not show significant differences after open or laparoscopic surgery.


CONCLUSIONS
Our findings indicate a less pronounced proinflammatory response to surgical trauma in patients after minimally invasive surgery. The nonspecific immune response appears to be less affected by laparoscopic surgery when compared with open surgery while the specific cell-mediated immunity is equally affected. These findings are important because a divergent effect on specific and nonspecific immunity of laparoscopic surgery for colorectal disease has not been reported before.
Wichmann
Matthias W
MW
Department of Surgery, Ludwig-Maximilians University, Klinikum Grosshadern, Munich, Germany. Matthias.Wichmann@med.uni-muenchen.de
Hüttl
Thomas P
TP
Winter
Hauke
H
Spelsberg
Fritz
F
Angele
Martin K
MK
Heiss
Markus M
MM
Jauch
Karl-Walter
KW
D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D015179:Colorectal Neoplasms / Q000276:immunology* / Q000401:mortality / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007111:Immunity, Cellular / Q000502:physiology*; D007121:Immunocompetence / Q000502:physiology; D018836:Inflammation Mediators / Q000032:analysis; D010535:Laparoscopy / Q000379:methods*; D007813:Laparotomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000276:immunology*; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D015996:Survival Rate; D016896:Treatment Outcome
D015415:Biomarkers; D018836:Inflammation Mediators