A Prospective Case-Control Study of the Local and Systemic Cytokine Response After Laparoscopic Versus Open Colonic Surgery

Sammour, Tarik; Kahokehr, Arman; Zargar‐Shoshtari, Kamran; Hill, Andrew G.

doi:10.1016/j.jss.2010.10.009

Cited by 18 publications

(26 citation statements)

References 71 publications

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“…Postoperative leukocyte (LC) function is restored earlier using laparoscopic surgery [48] and laparoscopy reduces the activation of mast cells and thus postsurgical inflammation and POI [49]. A recent meta-analysis including 13 studies demonstrated that open colorectal surgery for neoplasia is associated with higher serum levels of IL-6 and IL-1, inducing an intense immune and inflammatory response compared with laparoscopy [50]. In contrast, in another meta-analysis including 11 trials, sufficient evidence to support superior preservation of global immune function (T-suppressor lymphocytes CD8+, C-reactive protein) with laparoscopy could not be reached [51].…”

Section: Resultsmentioning

confidence: 99%

Fast-Track Surgery – Conditions and Challenges in Postsurgical Treatment: A Review of Elements of Translational Research in Enhanced Recovery after Surgery

Hoffmann¹,

Kettelhack²

2012

Eur Surg Res

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Background: Enhanced recovery after surgery (ERAS) or fast-track surgery is a perioperative and postoperative care concept initiated in the early 1990s aiming to reduce the length of hospital stays following elective abdominal surgery. Twenty treatment items defined in the Consensus Guidelines established in 2009 were included in this concept. The success of ERAS depends highly on multidisciplinary teamwork and patient compliance. Several ERAS items and their impact on perioperative and postoperative care have recently been discussed. In this connection, translational research topics triggered increasing interest in ERAS and new impulses aimed at improving the ERAS concept. We thus reviewed the surgical literature to highlight the role of translational research items in ERAS. Methods: A literature search of Medline®, PubMed® and the Cochrane Database was performed. Two investigators independently reviewed the abstracts and appropriate articles were included in this review. Results: Articles have been selected. The advantages of the ERAS concept over conventional postoperative care were established by four meta-analyses and several reviews. But, due to the lack of standardization of the protocols, the level of evidence is still low. The implementation of ERAS into clinical practice is furthermore hampered by the poor compliance with ERAS protocols and remains a challenge for the future. Moreover, recent trials challenge the role of some ERAS items, e.g. epidural anesthesia. Translational research trials investigating stress, immune and inflammatory response after surgery, new analgesic concepts, goal-directed fluid therapy and new drugs and substances to improve the outcome of ERAS provide first promising data but still need to be integrated in the ERAS concept. Conclusion: The Consensus Guidelines for ERAS are subject to the constant evolution of treatment strategies and implementation of translational research findings. Improvement of the compliance with ERAS protocols in surgical clinics and updating of ERAS items taking into account recent findings in translational research may improve the outcomes of ERAS but remain a long-term challenge in surgery for the next years.

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Section: Resultsmentioning

confidence: 99%

Fast-Track Surgery – Conditions and Challenges in Postsurgical Treatment: A Review of Elements of Translational Research in Enhanced Recovery after Surgery

Hoffmann¹,

Kettelhack²

2012

Eur Surg Res

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“…For example, whereas several randomized clinical trials (RCTs) indicated lower IL-6 levels following laparoscopy, 112,113 alterations in other key cytokines, including the immunosuppressive IL-10, are not clear, 114,115 neither are the effects on the number of circulating NK cells 112,116–118 and hormonal stress responses. 117,119 The lack of clear advantages for laparoscopic procedures according to these indices might be related to the more-complex nature of laparoscopic procedures, especially with regard to abdominal oncological surgeries.…”

Section: Surgical Aspects Affecting Recurrencementioning

confidence: 99%

Exploiting the critical perioperative period to improve long-term cancer outcomes

et al. 2015

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Evidence suggests that the perioperative period and the excision of the primary tumour can promote the development of metastases—the main cause of cancer-related mortality. This Review first presents the assertion that the perioperative timeframe is pivotal in determining long-term cancer outcomes, disproportionally to its short duration (days to weeks). We then analyse the various aspects of surgery, and their consequent paracrine and neuroendocrine responses, which could facilitate the metastatic process by directly affecting malignant tissues, and/or through indirect pathways, such as immunological perturbations. We address the influences of surgery-related anxiety and stress, nutritional status, anaesthetics and analgesics, hypothermia, blood transfusion, tissue damage, and levels of sex hormones, and point at some as probable deleterious factors. Through understanding these processes and reviewing empirical evidence, we provide suggestions for potential new perioperative approaches and interventions aimed at attenuating deleterious processes and ultimately improving treatment outcomes. Specifically, we highlight excess perioperative release of catecholamines and prostaglandins as key deleterious mediators of surgery, and we recommend blockade of these responses during the perioperative period, as well as other low-risk, low-cost interventions. The measures described in this Review could transform the perioperative timeframe from a prominent facilitator of metastatic progression, to a window of opportunity for arresting and/or eliminating residual disease, potentially improving long-term survival rates in patients with cancer.

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“…That study is specific for gynecological procedures, but similar findings have been reported in colorectal surgery, with long term results being equivocal (203,204). It has been suggested that the intraperitoneal pressure exerted by insufflation may play a role in adhesion formation through immune cell activation and histological damage, though the role of cytokine activation has been refuted (4,178,205,206). Similarly, constant irrigation, poorly targeted hemostasis, and less graceful suturing seen in laparoscopy may also fundamentally make the operation more traumatic to tissue (206).…”

mentioning

confidence: 56%

Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment

Beyene¹,

Kavalukas²,

Barbul³

2015

Current Problems in Surgery

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A Prospective Case-Control Study of the Local and Systemic Cytokine Response After Laparoscopic Versus Open Colonic Surgery

Cited by 18 publications

References 71 publications

Fast-Track Surgery – Conditions and Challenges in Postsurgical Treatment: A Review of Elements of Translational Research in Enhanced Recovery after Surgery

Fast-Track Surgery – Conditions and Challenges in Postsurgical Treatment: A Review of Elements of Translational Research in Enhanced Recovery after Surgery

Exploiting the critical perioperative period to improve long-term cancer outcomes

Intra-abdominal adhesions: Anatomy, physiology, pathophysiology, and treatment

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