title: Comparison of the acute-phase response after laparoscopic versus open aortobifemoral bypass surgery: a substudy of a randomized controlled trial.
abstract: OBJECTIVE
  Minimally invasive surgical techniques have been shown to reduce the inflammatory response related to a surgical procedure. The main objective of our study was to measure the inflammatory response in patients undergoing a totally laparoscopic versus open aortobifemoral bypass surgery. This is the first randomized trial on subjects in this population.
  
  
  METHODS
  This is a substudy of a larger randomized controlled multicenter trial (Norwegian Laparoscopic Aortic Surgery Trial). Thirty consecutive patients with severe aortoiliac occlusive disease eligible for aortobifemoral bypass surgery were randomized to either a totally laparoscopic (n=14) or an open surgical procedure (n=16). The inflammatory response was measured by perioperative monitoring of serum interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) at six different time points.
  
  
  RESULTS
  The inflammatory reaction caused by the laparoscopic procedure was reduced compared with open surgery. IL-6 was significantly lower after the laparoscopic procedure, measured by comparing area under the curve (AUC), and after adjusting for the confounding effect of coronary heart disease (P=0.010). The differences in serum levels of IL-8 and CRP did not reach statistical significance.
  
  
  CONCLUSIONS
  In this substudy of a randomized controlled trial comparing laparoscopic and open aortobifemoral bypass surgeries, we found a decreased perioperative inflammatory response after the laparoscopic procedure measured by comparing AUC for serum IL-6.
authors.affiliation: Institute of Clinical Medicine, University of Oslo; Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo.
authors.forename: Anne H
authors.initials: AH
authors.lastname: Krog
authors.affiliation: Department of Vascular Surgery, Østfold Central Hospital, Fredrikstad.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Sahba
authors.affiliation: Department of Vascular Surgery, Sørlandet Hospital HF, Kristiansand.
authors.forename: Erik M
authors.initials: EM
authors.lastname: Pettersen
authors.affiliation: Oslo Center for Biostatistics and Epidemiology (OCBE).
authors.forename: Irene
authors.initials: I
authors.lastname: Sandven
authors.affiliation: Institute of Clinical Medicine, University of Oslo; Hormone Laboratory, Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway.
authors.forename: Per M
authors.initials: PM
authors.lastname: Thorsby
authors.affiliation: Institute of Clinical Medicine, University of Oslo; Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo.
authors.forename: Jørgen J
authors.initials: JJ
authors.lastname: Jørgensen
authors.affiliation: Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo.
authors.forename: Jon O
authors.initials: JO
authors.lastname: Sundhagen
authors.affiliation: Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo.
authors.forename: Syed Ss
authors.initials: SS
authors.lastname: Kazmi
mesh_terms: D000210:Acute-Phase Reaction / Q000097:blood / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D000368:Aged; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D003251:Constriction, Pathologic; D005260:Female; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D018836:Inflammation Mediators / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009664:Norway; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
chemical_list: D015415:Biomarkers; C508606:CXCL8 protein, human; C508600:IL6 protein, human; D018836:Inflammation Mediators; D015850:Interleukin-6; D016209:Interleukin-8; D002097:C-Reactive Protein
keywords: C-reactive protein; inflammation; interleukin; laparoscopy; surgery; vascular