Granulocyte elastase and systemic cytokine response after laparoscopic-assisted and open resections in Crohn's disease

Hildebrandt, U.; Keßler, Katharina; Pistorius, G.; Lindemann, W.; Ecker, K. W.; Feifel, G.; Menger, Michael D.

doi:10.1007/bf02235052

Cited by 45 publications

(41 citation statements)

References 19 publications

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“…However, some authors have reported no evidence of improved cell-mediated immunity after laparoscopy [34,35,61]. Discrepancies like these underscore the multifactorial nature of systemic cell-mediated immunity and, perhaps, reflect the tender balance of an immune response only partially measured.…”

Section: Cell-mediated Immunitymentioning

confidence: 88%

The net immunologic advantage of laparoscopic surgery

2004

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The trauma of surgery evokes a variety of physiologic and immunologic alterations that should contribute to host defense. However, an exaggerated response to injury may result in immunosuppression and lead to significant postoperative morbidity and mortality. Laparoscopic surgery may result in less induced surgical trauma than conventional open surgery. Decreased postoperative pain and speedy functional recovery of laparoscopic patients may be attributable to the reduced inflammatory response and minimal immunosuppression. Inflammation, an early protective homeostatic immune response to injury, is characterized by the production of proinflammatory cytokines and by activation of cellular and humoral immune mechanisms. Postoperative levels of the inflammatory cytokines have been consistently lower after laparoscopic procedures, indicating a smaller degree of surgical insult and acute inflammatory reaction. Surgical stress derails the functions of both polymorphonuclear and mononuclear cells, which may lead to an increased risk of postoperative infection. Comparative studies of cellular immunity after laparoscopic and conventional surgery demonstrate immunologic advantage conferred by laparoscopy. Exaggerated activation of peritoneal immunity may lead to a relative local immunosuppression, resulting in ineffective intraperitoneal bacterial clearance and serious postoperative infections. Functions of the peritoneal macrophages are better preserved when laparotomy is avoided. Decreased perioperative stress may be particularly important for oncologic patients. Laparoscopic approaches may result in diminished perioperative tumor dissemination and better cancer outcomes. Although laparoscopy is "minimally invasive," systemic immune responses still are undeniably activated. However, laparoscopic surgery appears to induce a smaller injury, resulting in proportionally decreased immunologic changes. In addition to improved cosmesis and faster functional recovery, a patient undergoing laparoscopic surgery may benefit most from a net immunologic advantage.

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Section: Cell-mediated Immunitymentioning

confidence: 88%

The net immunologic advantage of laparoscopic surgery

2004

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“…Its role in surgical trauma has rarely been investigated [15]. Hypothetically, an increase in serum IL-10 levels might reflect the compensation of the surgical trauma-related inflammatory response and the initiation of the healing process.…”

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confidence: 99%

“…Patients with carcinoma/adenoma were randomly picked for either surgical procedure. Patients with Crohn's disease were randomly distributed to either surgical procedure in the Crohn's Disease Activity Index (CDAI) [14,15], gender, duration of disease, and the like. The result was homogeneous groups (CDAI mean: open, 232.4; laparoscopic, 239.7).…”

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confidence: 99%

Comparison of surgical stress between laparoscopic and open colonic resections

et al. 2003

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“…However, some authors have reported no evidence of improved immunity after laparoscopy. [8][9][10][11] In addition, port site metastases (PSM) and local recurrences, although occasionally observed, remain a disputable problem with laparoscopic surgery for cancer. 12,13 With respect to renal cell carcinoma (RCC), laparoscopy related studies on the host immunity are insufficient and incomplete.…”

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confidence: 99%

Early immune outcome of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma: a prospective, randomized study

Yang

Fan

Wei

et al. 2012

CUAJ

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Objectives: We evaluated differences in cytokine responses and T-lymphocyte subsets following retroperitoneal laparoscopic and conventional open radical nephrectomies for localized renal cell carcinoma (RCC). Methods: A total of 62 patients with T 1 N 0 M 0 staged RCC were randomized to either retro-laparoscopic (n = 31) or open (n = 31) radical nephrectomy. Plasma levels of interleukin-1β (IL-1β), IL-6, and tumour necrosis factor-alpha (TNF-α) were measured separately by enzyme linked immunosorbent assay (ELISA) preoperatively and on postoperative days 1 and 5. Levels + in the open group, returned to about preoperative levels (p < 0.05). Follow-up ranged from 4 to 14 months postoperatively in all 62 patients with a 100% cancerspecific survival rate in both groups. Conclusions: Retroperitoneal laparoscopic radical nephrectomy is associated with the milder cytokine responses caused by trauma and inflammation and the better preserved distribution of T-lymphocytes. IntroductionSince Clayman and colleagues in 1991 1 reported the first laparoscopic radical nephrectomy (LRN) for a tumour-bearing kidney, this technique has become increasingly popular because of milder postoperative pain, decreased hospital stay and shortened convalescence compared to the conventional open radical nephrectomy (ORN). During the last 20 years, with advances in instrumentation and surgeon experience, LRN has emerged as an equally effective and minimally morbid surgical alternative to ORN for selected kidney neoplasms. 2,3Surgical trauma provokes a variety of physiologic and immunologic changes in the host. The host's acute phase response to injury includes a complicated interaction among the metabolic, neuroendocrine and immune systems. This response is deemed to be proportional to the extent of the initial injury and is presumably directed toward the host defense. 4 Due to this altered immune response in the postoperative period, surgical trauma can cause an increased production of pro-inflammatory cytokines and an inhibition of cellular responses.5 A wealth of studies with intermediate to long-term follow-up results indicate that laparoscopic radical malignance resections offer equivalent safety and oncologic efficacy as compared to open surgical approaches.6,7 This is partially because of the reduced inflammatory response and minimal extent of immunosuppression. However, some authors have reported no evidence of improved immunity after laparoscopy. [8][9][10][11] In addition, port site metastases (PSM) and local recurrences, although occasionally observed, remain a disputable problem with laparoscopic surgery for cancer. 12,13 With respect to renal cell carcinoma (RCC), laparoscopy related studies on the host immunity are insufficient and incomplete. Whether and how the laparoscopy under CO 2 pneumoperitoneum could exert some negative influences on the RCC patients is still unclear.

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Granulocyte elastase and systemic cytokine response after laparoscopic-assisted and open resections in Crohn's disease

Cited by 45 publications

References 19 publications

The net immunologic advantage of laparoscopic surgery

The net immunologic advantage of laparoscopic surgery

Comparison of surgical stress between laparoscopic and open colonic resections

Early immune outcome of retroperitoneal laparoscopic radical nephrectomy for localized renal cell carcinoma: a prospective, randomized study

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