title: Surgical stress response after colorectal resection: a comparison of robotic, laparoscopic, and open surgery.
abstract: BACKGROUND
  The perioperative immune status of colorectal robotic surgery (RS), laparoscopic surgery (LS), and open surgery (OS) patients has not been compared. Our aim was to evaluate perioperative stress and immune response after RS, LS and OS.
  
  
  METHODS
  This prospective study included 46 colorectal surgery patients from the Department of Surgical Oncology of the University of Tokyo Hospital. Peripheral venous blood samples were obtained preoperatively and on postoperative days 1, 3, and 6. We evaluated expression of HLA-DR (marker of immune competence), C-reactive protein (CRP) levels, and lymphocyte subset counts (natural killers, cytotoxic T cells and helper T cells).
  
  
  RESULTS
  Fifteen, 23, and 8 patients underwent RS, LS and OS, respectively. HLA-DR expression was the lowest on day 1 and gradually increased on days 3 and 6 in all the groups. There was no significant difference in postoperative HLA-DR expression between the RS and LS group. However, on day 3, HLA-DR expression in the RS group was significantly higher than in the OS group (p = 0.04). On day 1, CRP levels in the LS group were significantly lower than in the RS group (p = 0.038). There were no significant perioperative changes in the lymphocyte subset cell count between the three groups.
  
  
  CONCLUSIONS
  Perioperative surgical stress, as evaluated by immunological parameters, was comparable between robotic and laparoscopic surgery and higher with open surgery. Robotic surgery may be an alternative to laparoscopic surgery, as a minimally invasive surgery option for colorectal cancer.
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, shibata200101545@yahoo.co.jp.
authors.forename: J
authors.initials: J
authors.lastname: Shibata
authors.forename: S
authors.initials: S
authors.lastname: Ishihara
authors.forename: N
authors.initials: N
authors.lastname: Tada
authors.forename: K
authors.initials: K
authors.lastname: Kawai
authors.forename: N H
authors.initials: NH
authors.lastname: Tsuno
authors.forename: H
authors.initials: H
authors.lastname: Yamaguchi
authors.forename: E
authors.initials: E
authors.lastname: Sunami
authors.forename: J
authors.initials: J
authors.lastname: Kitayama
authors.forename: T
authors.initials: T
authors.lastname: Watanabe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000378:metabolism; D002097:C-Reactive Protein / Q000378:metabolism; D003110:Colonic Neoplasms / Q000276:immunology / Q000601:surgery*; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D006801:Humans; D010535:Laparoscopy; D018655:Lymphocyte Count; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011184:Postoperative Period; D011446:Prospective Studies; D012004:Rectal Neoplasms / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D065287:Robotic Surgical Procedures; D013312:Stress, Physiological / Q000276:immunology*
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens; D002097:C-Reactive Protein