title: Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial.
abstract: OBJECTIVE
  To evaluate the effect of laparoscopic or open colectomy with fast track or standard perioperative care on patient's immune status and stress response after surgery.
  
  
  METHODS
  Patients with nonmetastasized colon cancer were randomized to laparoscopic or open colectomy with fast track or standard care. Blood samples were taken preoperatively (baseline), and 1, 2, 24, and 72 hours after surgery. Systemic HLA-DR expression, C-reactive protein, interleukin-6, growth hormone, prolactin, and cortisol were analyzed.
  
  
  RESULTS
  Nineteen patients were randomized for laparoscopy and fast track care (LFT), 23 for laparoscopy and standard care (LS), 17 for open surgery and fast track care (OFT), and 20 for open surgery and standard care (OS). Patient characteristics were comparable. Mean HLA-DR was 74.8 in the LFT group, 67.1 in the LS group, 52.8 in the OFT group, and 40.7 in the OS group. Repeated-measures 2-way analysis of variance (ANOVA) showed this can be attributed to type of surgery and not aftercare (P = 0.002). Interleukin-6 levels were highest in the OS group. Repeated-measures 2-way ANOVA showed this can be attributed to type of surgery and not aftercare (P = 0.001). C-reactive protein levels were highest in the OS group. Following repeated-measures 2-way ANOVA, this can be attributed to type of surgery and not aftercare (P = 0.022). Growth hormone was lowest in the LFT group. Following repeated-measures 2-way ANOVA, this can be attributed to type of aftercare and not to type of surgery (P = 0.033). No differences between the groups were seen regarding prolactin or cortisol. No differences in (infectious) complication rates were observed between the groups.
  
  
  CONCLUSIONS
  This randomized trial showed that immune function of HLA-DR in patients undergoing laparoscopic surgery with fast track care remains highest. This can be attributed to type of surgery and not aftercare. These results may indicate a reason for the accelerated recovery of patients treated laparoscopically within a fast track program as described in the LAparoscopy and/or FAst track multimodal management versus standard care (LAFA-Trial) (www.trialregister.nl, protocol NTR222).
authors.affiliation: Department of Surgery, VU University Medical Center, Academic Medical Center, Amsterdam, The Netherlands. a.veenhof@vumc.nl
authors.forename: A A F A
authors.initials: AA
authors.lastname: Veenhof
authors.forename: M S
authors.initials: MS
authors.lastname: Vlug
authors.forename: M H G M
authors.initials: MH
authors.lastname: van der Pas
authors.forename: C
authors.initials: C
authors.lastname: Sietses
authors.forename: D L
authors.initials: DL
authors.lastname: van der Peet
authors.forename: E S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.forename: H J
authors.initials: HJ
authors.lastname: Bonjer
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
mesh_terms: D000236:Adenoma / Q000097:blood / Q000276:immunology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002097:C-Reactive Protein / Q000378:metabolism; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003110:Colonic Neoplasms / Q000097:blood / Q000276:immunology / Q000601:surgery*; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood*; D019382:Human Growth Hormone / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011184:Postoperative Period; D011388:Prolactin / Q000097:blood; D013312:Stress, Physiological / Q000276:immunology*; D016896:Treatment Outcome
chemical_list: D006684:HLA-DR Antigens; D015850:Interleukin-6; D019382:Human Growth Hormone; D011388:Prolactin; D002097:C-Reactive Protein; D006854:Hydrocortisone