Comparison of surgical stress response to laparoscopic and open radical cystectomy.
OBJECTIVE
To prospectively compare stress response to laparoscopic and open radical cystectomy by the measurement of humoral mediators and the incidence of systemic inflammatory response syndrome (SIRS).


METHODS
Thirty-eight patients undergoing radical cystectomy were prospectively assessed. Blood samples were obtained from all patients before surgery, during surgery, 72 h after surgery. Serum levels of interleukin (IL)-6 and interferon (IFN)-gamma were measured using an enzyme-linked immunosorbent assay. We also investigated the incidence and duration of SIRS in the two groups.


RESULTS
The two groups had comparable perioperative variables except for less estimated blood loss in the laparoscopic group. The IL-6 levels increased during and after surgery in the two groups (P < 0.001). However, the IL-6 levels in the laparoscopic group were significantly lower than those in the open group during and after surgery (P = 0.006, P < 0.001). The incidence of SIRS was 57.1% in the laparoscopic group and 79.2% in the open group (P = 0.149). The mean duration of SIRS was 1.4 days in the laparoscopic group and 2.8 days in the open group (P = 0.032). The IFN-gamma levels decreased, but there was no difference in the two groups over the entire period assessed. Multivariate analysis demonstrated that the group (laparoscopic versus open) was the only influencing factor on the levels of IL-6 and the duration of SIRS.


CONCLUSIONS
Our study suggests that the laparoscopic group is markedly less stressful and it has a shorter duration of SIRS than the open group.
Department of Urology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, China.
Sheng-Zheng
SZ
Wang
Yu
Y
Chen
Huan-Yi
HY
Lin
Ling-Wu
LW
Chen
D000368:Aged; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D013312:Stress, Physiological / Q000276:immunology*; D001749:Urinary Bladder Neoplasms / Q000276:immunology* / Q000601:surgery*
D015415:Biomarkers; C508600:IL6 protein, human; D015850:Interleukin-6; D007371:Interferon-gamma