title: A model for lymphocyte activation in open versus laparoscopic surgery in colorectal cancer patients in enhanced recovery after surgery (ERAS) protocols.
abstract: OBJECTIVE
  Given the high mortality and morbidity associated with colon cancer worldwide and the advantages inherent to the use of the laparoscopy technique with respect to open surgery in oncological colorectal surgery, a study was designed to observe and compare the lymphocyte activation model between open surgery (OS) and laparoscopic surgery (LS) for this type of patient as part of an ERAS protocol.
  
  
  METHODS
  A prospective study was conducted with 38 patients who underwent surgery due to colorectal disease and were included in an ERAS protocol. The patients were divided into two groups: G1 (patients who had undergone OS; n = 19) and G2 (patients who had undergone LS; n = 19). The lymphocyte activation model was studied at three times: immediately prior to surgery and on post-operative days 1 and 3 (POD0, POD1 and POD3).
  
  
  RESULTS
  The Th lymphocyte activation markers studied (CD25, CD69, HLADR) exhibited a significantly higher mean value on POD0 for CD69 in OS than in LS (p = 0.037) and a significantly lower mean HLADR value on POD3 for OS than for LS (p = 0.040). No statistically significant differences were observed in either the evolution or in the mean values for the intracellular cytokines studied responsible for a Th1, Th2 or Th17 response. A Th1 response pattern was observed in both OS and LS.
  
  
  CONCLUSIONS
  The lymphocyte activation model in OS and LS is a Th1 response in both cases. The findings for the Th lymphocyte activation markers could indicate a better preserved immunity in LS with respect to OS.
authors.affiliation: Faculty of Medicine, University of Zaragoza, Zaragoza, Spain. amarmar@unizar.es.
authors.forename: Ana Belén
authors.initials: AB
authors.lastname: Martínez
authors.affiliation: Department of Anesthesia, Lozano Blesa Hospital, Zaragoza, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Longás
authors.affiliation: Department of Surgery, Lozano Blesa Hospital, Zaragoza, Spain.
authors.forename: J M
authors.initials: JM
authors.lastname: Ramírez
mesh_terms: D015179:Colorectal Neoplasms / Q000276:immunology* / Q000601:surgery*; D003710:Demography; D006801:Humans; D010535:Laparoscopy; D008213:Lymphocyte Activation / Q000276:immunology*; D018448:Models, Immunological; D006377:T-Lymphocytes, Helper-Inducer / Q000276:immunology
keywords: Colorectal cancer; ERAS; Immunological response after surgery; Laparoscopic surgery; Open surgery