title: Randomized clinical trial comparing inflammatory and angiogenic response after open versus laparoscopic curative resection for colonic cancer.
abstract: BACKGROUND
  Several studies have suggested that laparoscopy might confer an oncological advantage in patients undergoing surgery for colonic cancer. A decreased inflammatory and angiogenic response has been proposed. This study compared the local and systemic inflammatory and angiogenic responses after open and laparoscopic surgery for colonic cancer.
  
  
  METHODS
  Some 122 patients with colonic cancer were randomized to open or laparoscopic colectomy. Levels of interleukin (IL) 6 and vascular endothelial growth factor (VEGF) were measured in serum and peritoneal fluid at baseline, then at 4, 12, 24 and 48 h and on day 4 after surgery. Samples obtained on day 4 were tested in an in vitro angiogenesis assay, with measurement of number of capillaries per field and capillary length.
  
  
  RESULTS
  The serum IL-6 level was lower in the laparoscopic group at 4 h (mean(s.d.) 124(110) versus 244(326) pg/dl after open colectomy; P = 0·027). The serum VEGF concentration was also lower in the laparoscopic group at 48 h and day 4 (430(435) versus 650(686) pg/dl; P = 0·001). Overall, local IL-6 and VEGF levels were significantly higher than serum levels but there were no differences between groups. In vitro, postoperative serum and peritoneal fluid samples were potently angiogenic but there were no differences between open surgery and laparoscopy. Rates of tumour recurrence and survival were similar in the two groups.
  
  
  CONCLUSIONS
  Despite differences in postoperative serum levels of IL-6 and VEGF after open and laparoscopic surgery in patients with colonic cancer, the angiogenic response is comparable in both surgical approaches.
  
  
  BACKGROUND
  ISRCTN55624793 (http://www.controlled-trials.com).
authors.affiliation: Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Pascual
authors.forename: S
authors.initials: S
authors.lastname: Alonso
authors.forename: D
authors.initials: D
authors.lastname: Parés
authors.forename: R
authors.initials: R
authors.lastname: Courtier
authors.forename: M J
authors.initials: MJ
authors.lastname: Gil
authors.forename: L
authors.initials: L
authors.lastname: Grande
authors.forename: M
authors.initials: M
authors.lastname: Pera
mesh_terms: D000368:Aged; D003082:Colectomy / Q000379:methods; D003092:Colitis / Q000473:pathology; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D010535:Laparoscopy; D007902:Length of Stay; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000209:etiology; D009389:Neovascularization, Pathologic / Q000209:etiology; D011182:Postoperative Care; D011183:Postoperative Complications / Q000517:prevention & control*; D011300:Preoperative Care; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism
chemical_list: D015850:Interleukin-6; D042461:Vascular Endothelial Growth Factor A