Inflammatory response in laparoscopic vs. open surgery for gastric cancer.
OBJECTIVE
Laparoscopic surgery may offer advantages compared to open surgery, such as earlier mobilization, less pain and lower post-surgical morbidity. Surgical stress is thought to be associated with the postoperative immunological changes in the body as an impaired immune function, which may lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer.


METHODS
We conducted a literature search identifying relevant studies comparing laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters.


RESULTS
We identified seven studies that addressed the immunological status in patients undergoing laparoscopic or laparoscopy-assisted surgery compared to open surgery. IL-6 in circulation was found to be significantly reduced in laparoscopic patients. Furthermore, the plasma concentration of C-reactive protein was significantly lower in laparoscopic patients compared to patients undergoing laparotomy. Finally, most studies reported lower levels of white blood cell count in laparoscopic patients, although this result did not reach statistical significance in a small number of studies.


CONCLUSIONS
Laparoscopy-assisted gastric surgery seems to attenuate the immune response compared to open surgery. Larger and prospective studies are needed to further evaluate if the immunological status is relatively preserved in minimal invasive surgery and if this may reduce the postoperative complications compared to open surgery.
Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen , Blegdamsvej 9, 2100 Copenhagen , Denmark.
Cecilie
C
Okholm
Jens Peter
JP
Goetze
Lars Bo
LB
Svendsen
Michael Patrick
MP
Achiam
D002097:C-Reactive Protein / Q000378:metabolism; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D055633:Immune System Phenomena; D007249:Inflammation / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood; D010535:Laparoscopy; D007958:Leukocyte Count; D013274:Stomach Neoplasms / Q000601:surgery*
D015850:Interleukin-6; D002097:C-Reactive Protein
gastrectomy; gastric cancer; immune response; laparoscopic surgery; laparoscopy-assisted surgery; open gastric surgery; post-immunological status; surgical trauma