Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans

Whelan, Richard L.; Franklin, Morris E.; Holubar, Stefan D.; Donahue, Joseph; Fowler, Ryan; Munger, C.; Doorman, J.; Ballí, Jorge; Glass, Jeffrey L.; González, John J.; Bessler, Marc; Xie, Haiting; Treat, Michael R.

doi:10.1007/s00464-001-8263-y

Cited by 166 publications

(110 citation statements)

References 15 publications

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“…Two human DTH studies have been done, a cholecystectomy and a colectomy study; both were fairly small and nonrandomized. Both studies demonstrated that the open procedure was associated with a significant drop in the size of the response whereas the minimally invasive groups had smaller nonsignificant decreases [9,10]. These studies, and others, suggest that early after surgery cell-mediated immune function is better preserved after laparoscopic procedures.…”

Section: A Delayed-type Hypersensitivitymentioning

confidence: 93%

Immunologic Consequences and Considerations of the Laparoscopic Approach

Feingold¹,

Carter²,

Whelan³

2006

The Sages Manual

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The introduction of advanced laparoscopic operations in the early 1990s led to a close examination of the immunologic consequences of both open and closed surgical methods. This scrutiny has significantly increased our understanding of the impact of surgery on the body and will, it is hoped, lead to new perioperative pharmacologic therapies that will lessen the deleterious immunologic effects of all types of surgery. Before the laparoscopic era, it had been well established that major open surgery is associated with the temporary suppression of a variety of cells that are involved with both innate and specific immunity, including lymphocytes, neutrophils, monocytes, and macrophages. Interactions between cells, chemotaxis, expression of surface antigens, the ability to produce cytokines, and other functions of these immune system cells are negatively influenced by open surgical trauma. Further, the ability to mount a positive response to a delayed-type hypersensitivity (DTH) recall antigen challenge is suppressed after surgery [1][2][3][4][5].The relative contribution of each part of an abdominal procedure (abdominal wall access incision versus intraabdominal dissection and resection) to postsurgical immunosuppression had not been assessed before the advent of advanced laparoscopic methods. The results of recent studies suggest that the method of entry into the abdomen is the most important determinant of postoperative immune function. Minimally invasive methods, for a variety of immune parameters, have been shown to be associated with significantly better preserved function when compared to the equivalent open procedure. Of note, in many cases the differences are small and short lived, on the order of a day, and sometimes less for several variables. For a number of parameters no differences have been noted.It should be realized that the clinical significance, if any exists, of the immune function differences that have been found has not been determined. Better preserved postoperative cell-mediated immune function, in theory, may have an impact on the rate of infections and, possibly, tumor recurrence rates and survival.This chapter reviews the available literature in this area and also speculates on how our improved understanding of surgery's impact on the immune system may lead to novel perioperative treatments in the future.

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Section: A Delayed-type Hypersensitivitymentioning

confidence: 93%

Immunologic Consequences and Considerations of the Laparoscopic Approach

Feingold¹,

Carter²,

Whelan³

2006

The Sages Manual

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“…Hope-fully, this contributes to a decrease the typical propensity of pancreas allograft to thrombosis. Secondly, laparoscopic surgery reduces proinflammatory response [25], and results in lower immune suppression [26]. Although PT recipients receive vigorous immunosuppression, sparing some of the paths of innate immunity should be beneficial, especially in diabetics whose posttransplant course is typically plagued by infection.…”

Section: Discussionmentioning

confidence: 99%

Current Perspectives on Laparoscopic Robot-Assisted Pancreas and Pancreas-Kidney Transplantation

Boggi¹,

Signori²,

Vistoli³

et al. 2011

Rev Diabet Stud

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■ AbstractPancreas transplant recipients continue to suffer high surgical morbidity. Current robotic technology provides a unique opportunity to test whether laparoscopy can improve the post-operative course of pancreas transplantation (PT). Current knowledge on robotic pancreas and renal transplantation was reviewed to determine feasibility and safety of robotic PT. Information available from literature was included in this review, together with personal experience including three PT, and two renal allotransplants. As of April 2011, the relevant literature provides two case reports on robotic renal transplantation. The author's experience consists of one further renal allotransplantation, two solitary PT, and one simultaneous pancreas-kidney transplantation. Information obtained at international conferences include several other renal allotransplants, but no additional PT. Preliminary data show that PT is feasible laparoscopically under robotic assistance, but raises concerns regarding the effects of increased warm ischemia time on graft viability. Indeed, during construction of vascular anastomoses, graft temperature progressively increases, since maintenance of a stable graft temperature is difficult to achieve laparoscopically. There is no proof that progressive graft warming produces actual damage to transplanted organs, unless exceedingly long. However, this important question is likely to elicit a vibrant discussion in the transplant community.

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“…Minimizing the operative trauma leads to less immune supression, less impairment of plasma proteins and less stimulation of neoangiogenesis (6,7,9,14,19,20,21,26,27,28). These phenomenons, dependently of extensiveness of surgical procedure may contribute to unintended tumor growth and survival of cancer cells in the operative field, blood stream and distant organs.…”

Section: R E V I E W P a P E R Smentioning

confidence: 99%

“…In another study comparing postoperative immune system function after laparoscopic and open colectomy, fully preserved delayed-type hypersensivity after laparoscopic procedures was observed, while after laparotomy it was significantly suppressed (28). In the study, the response to 6 different antigens (mumps skin test antigen, tuberculine, Candida Albicans, Trichophyton, Aspergillus fumigatus, Histoplasmosis capsulatum) was evaluated before the procedure, directly after and on the 3 rd postoperative day.…”

Section: Review Of the Literaturementioning

confidence: 99%

“…Development of basic science provides modern knowledge pointing to the need for popularisation of miniinvasive methods of colon cancer treatment. Experimental studies prove, that operative trauma leads to tumor growth stimulation in the postoperative period (6,9,(19)(20)(21)(22)(23)28). Postoperative immunosupression consists of: decrease of total lymphocyte count, decrease of Th-1 lymphocytes, decrease of cytotoxic lymphocytes, inhibition of lymphocytes proliferation, suppression of NK cells, impaired monocyte human leukocyte antigen expression and suppression of delayed type hypersensivity response (7,9,27,28).…”

Section: Review Of the Literaturementioning

confidence: 99%

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