Systemic Cytokine Response After Laparoscopic-Assisted Resection of Rectosigmoid Carcinoma

Leung, Ka Lau; Lai, Paul B.S.; Ho, Raymond H.; Meng, Weiliang; Yiu, Raymond Y. C.; Lee, Janet F. Y.; Lau, Wan Yee

doi:10.1097/00000658-200004000-00008

Cited by 244 publications

(170 citation statements)

References 16 publications

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“…To test this hypothesis, we measured inflammatory markers in the serum of patients who had been treated surgically for herniated discs using MED, microscopic discectomy (MD) or open unilateral laminotomy. Early recovery from endoscopic surgery has been attributed to reduced local production of proinflammatory cytokines such as Interleukin-1 (IL-1), Interleukin-6 (IL-6) or tumor necrosis factor-alpha (TNF-a) [2,7,15,18]. In the present study, we collected laboratory data from patients who were treated surgically with MED for disc herniation.…”

Section: Introductionmentioning

confidence: 99%

Objective assessment of reduced invasiveness in MED

et al. 2005

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Microendoscopic discectomy (MED) has been accepted as a minimally invasive procedure for lumbar discectomy because of the small skin incision and short hospital stay required for this surgery. However, there are few objective laboratory data to confirm the reduced systemic responses in the early phase after this procedure. In order to substantiate the reduced invasiveness of MED compared to microdiscectomy (MD) or procedures involved in one-level unilateral laminotomy, the invasiveness of each surgical procedure was evaluated by measuring serum levels of biochemical parameters reflective of a postoperative inflammatory reaction and damage to the paravertebral muscles. Thirty-three patients who underwent lumbar discectomy or one-level unilateral laminotomy (MED in 15 cases, MD in 11 cases and one-level unilateral laminotomy in 7 cases with lumbar spinal canal stenosis) were included in this study. The serum levels of C-reactive protein (CRP) and creatine phosphokinase (CPK) were measured at 24 h after operation. Interleukin-6 (IL-6) and Interleukin-10 (IL-10) were measured at 2, 4, 8 and )24 h following the surgery to monitor the inflammatory response to the respective surgery. The post-operative serum CRP levels from both the MD and MED groups were significantly lower than those from the open laminotomy group. However, there was no significant difference in these serum levels between the MED and MD groups. The levels of IL-6 and IL-10 in the MED group during0 the first post-operative day were also significantly lower than those in the laminotomy group. When the MED and MD groups were compared, the IL-6 levels in the MED group were lower than in MD group at 2, 4 and 8 h after surgery, but the differences were not statistically significant. However, the level was significantly lower in the MED group at 24 h after surgery. In terms of IL-10, no significant difference was noted between the MED and MD groups over the study period. The changes in serum levels of postoperative inflammatory: markers (CRP, IL-6 and IL-10) in the early phase indicated reduced inflammatory reactions in MED as well as in MD when compared with classical open unilateral laminotomy. These data draw a direct link between the lower level of the inflammatory response and reduced invasiveness of MED. However, an indicator for muscle damage (CPK) appeared not to be affected by the type of surgical procedure used to correct disc herniation.Keywords Microendoscopic discectomy AE Microdiscectomy AE Lumbar disc herniation AE Minimally invasive surgery Eur Spine J (2006) 15: 577-582

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Section: Introductionmentioning

confidence: 99%

Objective assessment of reduced invasiveness in MED

et al. 2005

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“…Delgado et al, demostraron esto específicamente en cirugía de colon 8 . Además, la cirugía abierta tendría una mayor depresión de la respuesta inmune celular y alteraría en mayor medida la función de los polimorfonucleares, funciones importantes para evitar la diseminación de células neoplásicas y crecimiento tumoral, que probablemente adquiere mayor importancia en etapa III, donde el tumor escapa de lo local [7][8][9][10] . En nuestro estudio, el tamaño tumoral resultó un factor de riesgo para menor sobrevida libre de enfermedad.…”

Section: Discussionunclassified

“…Incluso en etapa III de la enfermedad se ha observado una ventaja para el abordaje laparoscópico, en al menos dos series de cáncer de recto 3,4 . No hay una razón específica que explique estos hallazgos, pero se ha postulado que la laparoscopia, por un menor stress quirúrgico, altera en menor medida la respuesta inmune, la cual tiene un rol importante en la progresión tumoral y la diseminación a distancia [5][6][7][8][9][10] . Sin embargo, los estudios son longitudinales comparativos, y no analizan en detalle el subgrupo de pacientes en etapa III, por lo que no está claro si se seleccionaron pacientes distintos para la técnica laparoscópica o abierta.…”

Section: Introductionunclassified

Resección laparoscópica en cáncer de recto etapa III: ¿mejor de lo que esperábamos?

Gellona

et al. 2013

Rev Chil Cir

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Laparoscopic Resection in Stage III Rectal Cancer: Better than we expected?Introduction: Laparoscopic approach to management of rectal cancer (CR) has shown similar results compared to conventional technique. In some series, patients in stage III showed a better survival function in laparoscopic approach. The aim of this study is to compare disease specific survival (SE) and disease free survival (SLE) in patients with stage III rectal cancer treated with radical surgery via laparoscopy or laparotomy. Method: Historic cohort study, all stage III patients treated with elective radical surgery for CR in the period between August 2005 and May 2012 were included. Demographic, surgical specimens and survivor function for SE and SLE were compared. Results: A total of 51 patients were included, 29 laparoscopic and 22 open. The groups were similar in demographic data. Number of lymph nodes, compromised lymph nodes and distal margin distance was significantly higher in the open approach. The percentage of low lymph node count was 9.1% in the open group and 34.5% in the laparoscopic group (p = 0.03). SE estimated at 5 years was 50% and 80% in the open and laparoscopic approach respectively (p = 0.019). On multivariate analysis, laparoscopic approach was an independent factor for better SE and SLE. Tumor size was an independent risk factor for poor SLE. Conclusion: In our series, laparoscopic approach would be and independent factor for better survival in patients with stage III CR. Tumor size would be associated with poor SLE.

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“…Furthermore, using relatively small incisions ranging from 5mm to 12mm [8], this approach leads to less wound complications, less postoperative pain, shorter recovery period, better cosmetics, and earlier return to employment and daily activities, hence greater patient satisfaction [9]- [11]. More technical advantages of laparoscopy include lower likelihood of infections and blood loss, improving the preservation of normal immune function, thus lower morbidity rate [10], [12]- [14].…”

Section: Introductionmentioning

confidence: 99%