title: Postoperative immunosuppression after open and laparoscopic liver resection: assessment of cellular immune function and monocytic HLA-DR expression.
abstract: OBJECTIVE
  Major abdominal procedures are strongly associated with postoperative immunosuppression and subsequent increased patient morbidity. It is believed that laparoscopic surgery causes less depletion of the systemic immune function because of the reduced tissue trauma. Various cytokines and monocytic HLA-DR expression have been successfully implemented to assess postoperative immune function. The aim of our study was to show the difference in immunologic profiles after minimally invasive versus conventional liver resection.
  
  
  METHODS
  Ten animals underwent either laparoscopic or conventional open left lateral liver resection. Flow cytometric characteristics of HLA-DR expression on monocytes and lipopolysaccharide-stimulated cellular secretion of tumor necrosis factor α, interferon γ, interleukin 6, and interleukin 8 were measured and analyzed in ex vivo whole blood samples. Intraoperative and postoperative clinical outcome parameters were also documented and evaluated.
  
  
  RESULTS
  All animals survived the procedures. Postoperative complications were fever (n = 3), wound infections (n = 2), and biloma (n = 1). Open surgery showed a morbidity rate of 80% compared with 40% after laparoscopic surgery. Laparoscopic liver resection showed no postoperative immunoparalysis. Major histocompatibility complex class II expression in this group was elevated, whereas the open surgery group showed decreased major histocompatibility complex class II expression on postoperative day 1. Postoperative secretion of tumor necrosis factor , interleukin 6, and interferon was lower in the open surgery group. Elevated transaminase levels after laparoscopy might have resulted from an ischemia/reperfusion injury caused by the capnoperitoneum.
  
  
  CONCLUSIONS
  Major immunoparalysis depression was not observed in either group. Laparoscopic surgery shows a tendency to improve immunologic recovery after liver resection.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. sascha.chopra@charite.de.
authors.forename: Sascha S
authors.initials: SS
authors.lastname: Chopra
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Haacke
authors.affiliation: Institute of Medical Immunology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Meisel
authors.affiliation: Institute of Medical Immunology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Unterwalder
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Fikatas
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany.
authors.forename: Sven C
authors.initials: SC
authors.lastname: Schmidt
mesh_terms: D000818:Animals; D016207:Cytokines / Q000276:immunology*; D005260:Female; D006684:HLA-DR Antigens / Q000096:biosynthesis / Q000276:immunology*; D006498:Hepatectomy / Q000379:methods*; D007108:Immune Tolerance; D007111:Immunity, Cellular; D010535:Laparoscopy; D008099:Liver; D009000:Monocytes / Q000276:immunology* / Q000378:metabolism; D013552:Swine; D014409:Tumor Necrosis Factor-alpha
chemical_list: D016207:Cytokines; D006684:HLA-DR Antigens; D014409:Tumor Necrosis Factor-alpha