title: Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program.
abstract: OBJECTIVE
  It has been demonstrated that colon operation combined with fast-track (FT) surgery and laparoscopic technique can shorten the length of hospital stay, accelerate recovery of intestinal function, and reduce the occurrence of post-operative complications. However, there are no reports regarding the combined effects of FT colon operation and laparoscopic technique on humoral inflammatory cellular immunity.
  
  
  METHODS
  This was a prospective, controlled study. One hundred sixty-three colon cancer patients underwent the traditional protocol and open operation (traditional open group, n=42), the traditional protocol and laparoscopic operation (traditional laparoscopic group, n=40), the FT protocol and open operation (FT open group, n=41), or the FT protocol and laparoscopic operation (FT laparoscopic group, n=40). Blood samples were taken prior to operation as well as on days 1, 3, and 5 after operation. The number of lymphocyte subpopulations was determined by flow cytometry, and serum interleukin-6 and C-reactive protein levels were measured. Post-operative hospital stay, post-operative morbidity, readmission rate, and in-hospital mortality were recorded.
  
  
  RESULTS
  Compared with open operation, laparoscopic colon operation effectively inhibited the release of post-operative inflammatory factors and yielded good protection via post-operative cell immunity. FT surgery had a better protective role with respect to the post-operative immune system compared with traditional peri-operative care. Inflammatory reactions, based on interleukin-6 and C-reactive protein levels, were less intense following FT laparoscopic operation compared to FT open operation; however, there were no differences in specific immunity (CD3+ and CD4+ counts, and the CD4+/CD8+ ratio) during these two types of surgical procedures. Post-operative hospital stay in patients randomized to the FT laparoscopic group was significantly shorter than in the other three treatment groups (P<0.01). Post-operative complications in patients who underwent FT laparoscopic treatment were less than in the other three treatment groups (P<0.05). There were no significant differences between the four treatment groups regarding readmission rate and in-hospital mortality.
  
  
  CONCLUSIONS
  The laparoscopic technique and FT surgery rehabilitation program effectively inhibited release of post-operative inflammatory factors with a reduction in peri-operative trauma and stress, which together played a protective role on the post-operative immune system. Combining two treatment measures during colon operation produced better protective effects via the immune system. The beneficial clinical effects support that the better-preserved post-operative immune system may also contribute to the improvement of post-operative results in FT laparoscopic patients.
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, School of Medicine, Nanjing University, Nanjing, 210002, Jiangsu Province, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Wang
authors.forename: Zhiwei
authors.initials: Z
authors.lastname: Jiang
authors.forename: Kun
authors.initials: K
authors.lastname: Zhao
authors.forename: Guoli
authors.initials: G
authors.lastname: Li
authors.forename: Fengtao
authors.initials: F
authors.lastname: Liu
authors.forename: Huafeng
authors.initials: H
authors.lastname: Pan
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003082:Colectomy / Q000379:methods* / Q000401:mortality / Q000534:rehabilitation; D003110:Colonic Neoplasms / Q000276:immunology / Q000401:mortality / Q000601:surgery*; D005260:Female; D005434:Flow Cytometry; D017052:Hospital Mortality; D006801:Humans; D056724:Immunity, Humoral; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy / Q000401:mortality / Q000534:rehabilitation; D007902:Length of Stay / Q000706:statistics & numerical data; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D015850:Interleukin-6; D002097:C-Reactive Protein