Prospective evaluation of the systemic immune response following abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy

Malik, Eduard; Buchweitz, O.; Müller‐Steinhardt, Michael; Kressin, P.; Meyhöfer-Malik, A.; Diedrich, K.

doi:10.1007/s004640000348

Cited by 42 publications

(23 citation statements)

References 11 publications

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“…In contrast to certain studies in which no significant change was found in the CRP concentration between females undergoing laparoscopically assisted vaginal hysterectomy and those undergoing abdominal hysterectomy (28), we verified that there was a significantly less severe increase in serum IL-6 levels after laparoscopic cervical surgery. Our data are in accordance with those of previous studies (29)(30), which reported that the serum concentration of IL-6 and CRP is significantly different in the laparoscopy and conventional surgery groups.…”

Section: Discussionsupporting

confidence: 93%

“…CRP is the prototypical acute-phase protein in humans and is a significant mediator of immune host defense (24)(25)(26). Normal baseline levels of circulating CRP are low, but a many-fold increase may occur within hours of inflammation induced by infection or injury (29). Serum CRP levels are elevated as a result of major surgery, but have not always reflected the magnitude of acute trauma after open and laparoscopic surgery since CRP is a non-specific marker of an acute-phase reaction (31).…”

Section: Discussionmentioning

confidence: 99%

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Comparative evaluation of surgical stress of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy and laparotomy for early-stage cervical cancer

Hou

Jiang

et al. 2011

Oncology Letters

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Abstract. The aim of this study was to objectively evaluate the benefits of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy for early-stage cervical cancer. Clinical data were prospectively collected from patients with IA-IIB cervical cancer who underwent laparoscopically assisted vaginal radical hysterectomy (n1=33) and laparotomy (n2=30). Peripheral blood samples were obtained prior to surgery and at 1 and 2 h into the operation, as well as on days 1, 4 and 7 following surgery to measure serum interleukin-6, C-reaction protein and cortisol. Results showed that there was no conversion to laparotomy in the laparoscopy group. The average blood loss was 317.23±217.20 ml (laparoscopy group) and 872.58±693.16 ml (laparotomy group). No significant difference was found in the number of resected pelvic lymph nodes (19.74±7.43 in the laparoscopy group and 20.35±6.62 in the laparotomy group). At days 1 and 7 after surgery, the serum IL-6 level was significantly different in the laparoscopy and laparotomy groups (day 1: laparoscopy group 17.14±16.53 pg/ml and laparotomy group 34.32±20.97 pg/ml, p= 0.001; day 7: laparoscopy group 6.7±7.21 pg/ml and laparotomy group 17.54±16.47 pg/ml, p=0.001). The serum CRP level was significantly different at days 1 and 7 after the operation (day 1: laparoscopy group 7024.72±949.12 ng/ml and laparotomy group 7586.61±869.42 ng/ml, p=0.018; day 7: laparoscopy group 4357.71±2108.85 ng/ml and laparotomy group 6967.96±995.02 ng/ml, p<0.001). A significant difference was noted in the serum cortisol level at day 4 after the operation (122.29±65.17 ng/ml in the laparoscopy group and 186.76±68.61 ng/ml in the laparotomy group, p<0.001). In conclusion, the differences in clinical data and the various parameters pertinent to surgical stress evaluated in this study suggest that laparoscopic surgery for cervical cancer causes less postoperative stress than conventional open surgery.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of surgical stress of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy and laparotomy for early-stage cervical cancer

Hou

Jiang

et al. 2011

Oncology Letters

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“…In a smaller study comparing laparoscopic cholecystectomy with minilaparotomy to (5±7-cm incision), McMahon et al [19] found no dierence between the two methods, which may be due to the small size of the study and to the lesser extent of tissue trauma with a minilaparotomy. Malik et al [18] evaluated the systemic immune response following hysterectomy performed via laparotomy with the vaginal route, assisted or not by laparoscopy. The IL-6 and CRP levels increased the least with the vaginal route, slightly more if laparoscopic assistance was necessary, and much more with the abdominal approach.…”

Section: Discussionmentioning

confidence: 99%

Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure

2002

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“…After acute injury, IL-6 primarily regulates the hepatic component of the immune response and influences the production of such acute-phase proteins as C-reactive protein (CRP), fibrinogen, haptoglobin, and a1-antitrypsin, among others [7,51]. Surgery provokes an increase in circulating levels of IL-6 within 1 to 3 hours.…”

Section: Acute Inflammatory Reactionmentioning

confidence: 99%

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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Prospective evaluation of the systemic immune response following abdominal, vaginal, and laparoscopically assisted vaginal hysterectomy

Abstract: Elevated IL-6 levels subsequent to AH may reflect significantly greater tissue damage in these patients than in patients who undergo VH or LAVH. LAVH should therefore be considered in cases that cannot be managed by the vaginal route alone.

Cited by 42 publications

References 11 publications

Comparative evaluation of surgical stress of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy and laparotomy for early-stage cervical cancer

Comparative evaluation of surgical stress of laparoscopically assisted vaginal radical hysterectomy and lymphadenectomy and laparotomy for early-stage cervical cancer

Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure

The net immunologic advantage of laparoscopic surgery

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