Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer.
OBJECTIVE
The aim of this study was to assess cellular and peritoneal immune responses after radical laparoscopic surgery in gastric cancer.


METHODS
Peripheral heparinized plasma and plain serum tube samples were collected preoperatively, and at 2 hr, 1 day, and 4 days postoperatively for analysis o; white blood cells, total lymphocytes, T-helper lymphocytes, T-suppressor lymphocytes, B-lymphocytes, natural killer cells, plasma C-reactive protein and serum amyloid-A. Twenty-four hours peritoneal fluid collection was performed on days 1 and 4 for TNF-alpha, IL-6, and IL-10 analysis.


RESULTS
No statistical differences were observed between the two groups with respect to immunocompetent cell counts. The serum levels of plasma CRP and SAA gradually increased significantly with time in both groups, but these temporal increases were lower in the LADG group (CRP; P = 0.03, SAA; P = 0.01). Peritoneal TNF-alpha levels in the CODG group at 4 days postoperatively were significantly higher than at day 1, but remained almost unchanged in the LADG group, and this difference was significant (P = 0.02).


CONCLUSIONS
Because of its association with reduced peritoneal immune activity, laparoscopic surgery for advanced gastric cancer may require careful consideration in practice. Additional, larger prospective multicenter trials are required before a consensus can be reached.
Department of Surgery, Dong-A University College of Medicine, Busan, Korea.
Il-Kwon
IK
Jung
Min-Chan
MC
Kim
Kyeong-Hee
KH
Kim
Jong-Young
JY
Kwak
Ghap-Joong
GJ
Jung
Hyung-Ho
HH
Kim
D000209:Acute-Phase Proteins / Q000378:metabolism; D001202:Ascitic Fluid / Q000276:immunology; D002097:C-Reactive Protein / Q000378:metabolism; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D007111:Immunity, Cellular / Q000276:immunology*; D016753:Interleukin-10 / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism; D010535:Laparoscopy / Q000009:adverse effects*; D007902:Length of Stay; D007958:Leukocyte Count; D018655:Lymphocyte Count; D010537:Peritoneum / Q000276:immunology*; D011184:Postoperative Period; D000685:Serum Amyloid A Protein / Q000378:metabolism; D013274:Stomach Neoplasms / Q000601:surgery*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D000209:Acute-Phase Proteins; D015850:Interleukin-6; D000685:Serum Amyloid A Protein; D014409:Tumor Necrosis Factor-alpha; D016753:Interleukin-10; D002097:C-Reactive Protein