Impact of Immune Response in Short-term and Long-term Outcomes After Minimally Invasive Surgery for Colorectal Liver Metastases: Results From a Randomized Study

Abstract

Background: The potential benefit related to laparoscopic liver surgery (LLS) for colorectal liver metastases outcomes is not well known.Materials and Methods: Serum cytokines associated with Th1 (tumor necrosis factor-α) and Th2 [interleukin (IL)-10 and IL-6] phenotypes were measured in 36 patients operated on for colorectal liver metastases by open liver surgery (OLS) and LLS. Measurements were performed at 3 time points: 1 day before surgery, day 3 postoperative, and 1 month postoperative. We compared the postoperative inflammatory response influence between LLS and OLS on long-term outcomes.Results: In both groups, only IL-6 levels on day 3 postoperative were higher than those measured preoperatively and at 1 month. Comparing the tumor necrosis factor-α levels between the LLS and OLS groups, preoperative (7.28 vs. 2.36), day 3 (7.99 vs. 4.08) and 1 month (7.39 vs. 1.99) postoperative levels were higher in the OLS group (P < 0.01, <0.01, and <0.01, respectively). In contrast, IL-10 levels were higher in the LLS group preoperatively (7.51 vs. 4.57) and on day 3 postoperative (13.40 vs. 4.57) (P = 0.03 and 0.01, respectively). A cut-off IL-6 level of ≥ 4.41 in the first month was associated with a higher risk of recurrence (logrank = 4.8, P = 0.02).Conclusions: Both LLS and OLS induce an initial increase in IL-6 that normalizes one month after surgery, showing a similar pattern. In addition, a cut-off IL-6 value of 4.41 pg/mL was established, with a higher concentration at 1 month postoperative possibly related to a higher risk or recurrence.

Systemic Inflammation in Oncologic Patients Undergoing Systemic Treatment and Receiving Whey Protein-Based Nutritional Support

“…These differences might be related to the type of measured cytokine, since after surgery, interferon-γ (IFN-γ) is more affected; this cytokine has been related to tumor progression and metastasis and was not evaluated in this study, since we focused on sarcopenia or nutrition-related cytokines. Additionally, the type of surgery and the time that has elapsed since the intervention also influence the systemic inflammatory status [ 22 , 23 ], which is lower with minimally invasive techniques, and increased in major surgery [ 24 ] or in the period immediately following the procedure [ 25 , 26 ]. On the other hand, it is reasonable to think that the elimination of the tumor mass decreases the proinflammatory state.…”

Analgesia and stress attenuation of ultrasound‐guided modified pectoral nerve block type‐II with different volumes of 0.3% ropivacaine in patients undergoing modified radical mastectomy for breast cancer: A prospective parallel randomized double‐blind controlled clinical trial

“…In addition, the stress from surgical procedures can cause inflammatory responses, with increased production and release of various cytokines, such as interleukin‐1β (IL‐1β) and IL‐6 5–7 . Excessive inflammatory responses can delay wound healing and surgical recovery 8,9 . Therefore, appropriate management of postoperative pain and inflammatory responses is important during modified radical mastectomy.…”

“…[5][6][7] Excessive inflammatory responses can delay wound healing and surgical recovery. 8,9 Therefore, appropriate management of postoperative pain and inflammatory responses is important during modified radical mastectomy. Various analgesic methods have been applied to improve the surgical outcomes.…”

Minimally Invasive Surgery in Liver Transplantation: From Living Liver Donation to Graft Implantation

“…Nowadays, the efficacy and safety of MIS, even on patients with the above contraindications, has been scientifically proven [5]. The above findings have led to the application of MIS in liver transplant recipients as well as living liver donors, with potentially better outcomes than the traditional open techniques [6,7].…”