Inflammatory response after laparoscopic and conventional colorectal resections - results of a prospective randomized trial

Schwenk, W.; Jacobi, C. A.; Mansmann, Ulrich; Böhm, Bartholomäus; Müller, Jochen

doi:10.1007/s004230050002

Cited by 190 publications

(140 citation statements)

References 38 publications

(44 reference statements)

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“…Prospective randomized and non-randomized trials have compared the postoperative changes in immunologic and inflammatory parameters of different surgical procedures [6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46](table 1, 2). Most studies were performed in patients undergoing cholecystectomy, mainly showing a less pronounced postoperative increase in C-reactive protein, IL-1 and IL-6 for the laparoscopic approach, while the results of the systemic cellular changes differed between the different studies [9, 10, 13, 18, 22, 25, 27, 30, 32, 34, 39, 44].…”

Section: Clinical Trials Comparing the Impact Of Laparoscopic And Conmentioning

confidence: 99%

Immunologic Changes during Minimally Invasive Surgery

Jacobi¹,

Wenger²,

Opitz³

et al. 2002

Dig Surg

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Although recent experimental and clinical trials have documented that postoperative inflammation and changes in different immunologic parameters are less pronounced after laparoscopic approaches in comparison to open surgery, it still remains unclear what influence the pneumoperitoneum itself has on immunologic defense and function. This is mainly due to the endpoints of the different studies which investigate changes in the so-called immunologic parameters (cell subunits, C-reactive protein, cytokines, catecholamines or other stress hormones in plasma samples) rather than analyzing immunologic functions, such as cell activation, production of proteins, cell proliferation or in vivo immune defenses. So far, especially in clinical trials, no correlation has been demonstrated between the changes in immunologic parameters and relevant postoperative clinical endpoints, such as postoperative complications. Thus further clinical prospective randomized studies with relevant clinical endpoints and additional investigations of immunologic parameters are needed to prove the consequences of either minimally invasive surgery or open procedures on postoperative immune functions.

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Section: Clinical Trials Comparing the Impact Of Laparoscopic And Conmentioning

confidence: 99%

Immunologic Changes during Minimally Invasive Surgery

Jacobi¹,

Wenger²,

Opitz³

et al. 2002

Dig Surg

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“…2). Schwenk et al [36] also observed significantly lower IL-6 and CRP plasma levels after laparoscopic than after conventional colorectal resections while IL-1RA and IL-10 levels showed no significant differences between both study groups. Moreover, the evaluation of the immune status after laparoscopic and conventional colorectal surgery by flow cytometry revealed significantly higher numbers of circulating natural killer cells in patients after minimal invasive colorectal resection ( fig.…”

Section: Immunological Effectsmentioning

confidence: 88%

Recent Advances in Minimally Invasive Colorectal Cancer Surgery

et al. 2002

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SummaryLaparoscopy has improved surgical treatment of various diseases due to its limited surgical trauma and has developed as an interesting therapeutic alternative for the resection of colorectal cancer. Despite numerous clinical advantages (faster recovery, less pain, fewer wound and systemic complications, faster return to work) the laparoscopic approach to colorectal cancer therapy has also resulted in unusual complications, i.e. ureteral and bladder injury which are rarely observed with open laparotomy. Moreover, pneumothorax, cardiac arrhythmia, impaired venous return, venous thrombosis as well as peripheral nerve injury have been associated with the increased intraabdominal pressure as well as patient's positioning during surgery. Furthermore, undetected small bowel injury caused by the grasping or cauterizing instruments may occur with laparoscopic surgery. In contrast to procedures performed for nonmalignant conditions, the benefits of laparoscopic resection of colorectal cancer must be weighed against the potential for poorer long-term outcomes of cancer patients that still has not been completely ruled out. In laparoscopic colorectal cancer surgery, several important cancer control issues still are being evaluated, i.e. the extent of lymph node dissection, tumor implantation at port sites, adequacy of intraperitoneal staging as well as the distance between tumor site and resection margins. For the time being it can be assumed that there is no significant difference in lymph node harvest between laparoscopic and open colorectal cancer surgery if oncological principles of resection are followed. As far as the issue of port site recurrence is concerned, it appears to be less prevalent than first thought (range 0-2.5%), and the incidence apparently corresponds with wound recurrence rates observed after open procedures. Short-term (3-5 years) survival rates have been published by a number of investigators, and survival rates after laparoscopic surgery appears to compare well with data collected after conventional surgery for colorectal cancer. However, long-term results of prospective randomized trials are not available. The data published so far indicate that the oncological results of laparoscopic surgery compare well with the results of the conventional open approach. Nonetheless, the limited information available from prospective studies leads us to propose that minimally invasive surgery for colorectal cancer surgery should only be performed within prospective trials. Vorteile der laparoskopischen Chirurgie bei malignen Erkrankungen gegen die potentiell schlechteren onkologischen Langzeitergebnisse abgewogen werden, welche bislang noch nicht endgültig ausgeschlossen werden konnten. Diesbezüglich gibt es wesentliche onkologische Kriterien, die sich bei der laparoskopischen Chirurgie noch in der Evaluation befinden. Hierzu zählen unter anderem das Ausmaß der Lymphknotendissektion, die Frage der Tumorzellimplantation im Bereich der Trokarinzisionen, die Qualität des intraoperativen Tumor-Stagings sowie ...

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“…In addition, LAPR avoids laparotomy which is painful. As result, recovery time is shorter which shortens the postoperative hospital stay [9] After finishing treatment, these patients were followed by CEA every 3 months, repeat colonoscopy one year after diagnosis, CT chest and abdomen annually and physical exam and history every 3 months. Present studies [1] [4]…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Abdominoperineal Resection for Low Rectal Cancer at National Cancer Hospital of Vietnam

Pham¹,

Pham²,

Kim³

et al. 2017

OALib

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Introduction: Results of laparoscopic colectomies from developing nations are reported rarely. We report our results of laparoscopic abdominoperineal resection (LAPR) for low rectal cancer at K Hospital (National Cancer Hospital of Vietnam). Materials & Methods: From January 2012 to December 2015, a total of 135 patients who were diagnosed with low rectal adenocarcinoma were recruited to evaluate for LAPR surgical outcome performed at the K Hospital in Vietnam. The goal of the study was to compare post-surgical data from K Hospital with Western countries. Data were collected including age, gender, history of previous abdominal surgery, operative time, estimated blood loss (EBL), conversion rate, number of harvested lymph nodes, complications, time to return of bowel function (TRBF), length of stay (LOS), TNM staging and overall survival. Results: There were 69 male and 66 female patients. The mean age at diagnosis was 55.3 years (range 29 -68 years). 19 patients had previous abdominal surgeries. One patient had a conversion to open LAPR due to ureteral and bladder injury. The mean and standard deviation for number of harvested lymph nodes was 14.6 ± 5.3; mean operative time 133 ± 20.9 minutes and mean EBL 13.6 ± 12.2 ml. There were two cases of urinary retention that required bladder catheterization for more than 48 hours. There was no perioperative mortality. The TRBF was 33 ± 4.4 hours. Mean LOS was 7.4 ± 1.8 days. 98 patients (72.6%) had stage II and 37 patients (27.4%) had stage III disease. The overall 1-year, 2-year and 3-year survival was 95.8%, 82.1% and 73.3%, respectively. Conclusion: LAPR for low rectal cancer in K hospital is feasible and safe.

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Inflammatory response after laparoscopic and conventional colorectal resections - results of a prospective randomized trial

Abstract: IL-6 and CRP plasma levels were lower after laparoscopic than conventional colorectal resections. The less intense inflammatory response may be an indicator of the milder surgical trauma inflicted by laparoscopic than conventional colorectal resection.

Cited by 190 publications

References 38 publications

Immunologic Changes during Minimally Invasive Surgery

Immunologic Changes during Minimally Invasive Surgery

Recent Advances in Minimally Invasive Colorectal Cancer Surgery

Laparoscopic Abdominoperineal Resection for Low Rectal Cancer at National Cancer Hospital of Vietnam

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