title: Laparoscopically assisted colorectal surgery provides better short-term clinical and inflammatory outcomes compared to open colorectal surgery.
abstract: BACKGROUND
  Changes in immune function after surgery may influence overall outcome, length of hospital stay, susceptibility to infection and perioperative tumour dissemination in cancer patients. Our aim was to elaborate on postoperative differences in the immune status and the intensity of the systemic inflammatory response between two groups of prospectively enrolled patients with colorectal cancer, namely patients undergoing laparoscopically assisted or open colorectal surgery.
  
  
  METHODS
  Blood samples from 77 patients were taken before surgery and then 3 h, 24 h and 4 days after surgery. The inflammatory response was determined by leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin levels (PCT). Immune status was determined by phenotypic analysis of lymphocyte populations and the activation of mononuclear cells. CD64 expression and cytokine expression were also determined.
  
  
  RESULTS
  Patients undergoing laparoscopically assisted surgery had less intraoperative blood loss (p = 0.002), earlier resumption of diet (p = 0.002) and shorter hospital stay (p = 0.02). Numbers of total leukocytes (p = 0.12), CRP (p = 0.002) and PCT (p = 0.23) were remarkably higher 4 days after surgery in patients who underwent an open colorectal procedure. There was an important decrease in monocyte HLA-DR expression 3 h after surgery in patients undergoing laparoscopically assisted surgery (p = 0.03).
  
  
  CONCLUSIONS
  Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer. The acute inflammatory response is less pronounced. Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes. However, our results corroborate the results of previous studies.
authors.affiliation: Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Jurij
authors.initials: J
authors.lastname: Janež
authors.affiliation: Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Tina
authors.initials: T
authors.lastname: Korać
authors.affiliation: Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Anamarija Rebolj
authors.initials: AR
authors.lastname: Kodre
authors.affiliation: Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia.
authors.forename: Franc
authors.initials: F
authors.lastname: Jelenc
authors.affiliation: Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Alojz
authors.initials: A
authors.lastname: Ihan
keywords: cancer of colon and rectum; immune status; laparoscopic surgery