title: Systemic immunologic and inflammatory response after laparoscopic versus open nephrectomy: a prospective cohort trial.
abstract: OBJECTIVE
  To compare the dynamics of systemic inflammatory indices during laparoscopic nephrectomy (LN) and standard open donor nephrectomy.
  
  
  METHODS
  Participants in this cohort study were 54 adults without a history of renal surgery and no evidence of urinary tract infection who underwent transperitoneal LN (n=29) and open donor nephrectomy (n=25, control group). We recorded demographic characteristics, intraoperative parameters, and changes 24 hours postoperatively in systemic inflammatory and immunologic values (body temperature, concentrations of white blood cell count [WBC], C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-α), and compared the mean changes between groups.
  
  
  RESULTS
  Mean age was older in the LN group (45.6 vs 30.9 years; P<0.0001), and mean operative time was significantly shorter (83.1 min vs 101.6 min; P=0.004). Mean postoperative increase in IL-6 and body temperature in LN was significantly less than in control: For IL-6, 15.87 vs 29.09 pg/mL, P=0.03; for body temperature, +0.22°C vs +0.71°C, P=0.001). Mean postoperative increases in levels of other inflammatory markers (CRP, TNF-α, WBC) did not differ significantly. No statistical correlation was found between operative time and changes in IL-6, CRP, TNF-α, WBC, or body temperature.
  
  
  CONCLUSIONS
  Based on the smaller increase in serum IL-6 as the most important indicator of surgical stress, the surgical trauma-induced immune dysfunction may be less intense after LN than open surgery. This may explain the smooth convalescence after LN.
authors.affiliation: Department of Urology, Shiraz University of Medical Sciences, Shiraz, Iran. aminsharifi_ar@yahoo.com
authors.forename: Alireza
authors.initials: A
authors.lastname: Aminsharifi
authors.forename: Mehdi
authors.initials: M
authors.lastname: Salehipoor
authors.forename: Hamid
authors.initials: H
authors.lastname: Arasteh
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood*; D005260:Female; D006801:Humans; D007107:Immune System / Q000378:metabolism; D007249:Inflammation / Q000097:blood* / Q000276:immunology*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011182:Postoperative Care; D011446:Prospective Studies
chemical_list: D015415:Biomarkers