Systemic inflammatory response after laparoscopic and conventional colectomy for cancer: a matched case–control study

Tsamis, Dimitrios; Theodoropoulos, George; Stamopoulos, Paraskevas; Siakavellas, Spyridon; Delistathi, Thalassini; Michalopoulos, Nikolaos V.; Zografos, George

doi:10.1007/s00464-011-2052-z

Cited by 28 publications

(24 citation statements)

References 49 publications

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“…In the early post-operative period, better reserved cellular immune responses such as higher levels of total lymphocytes, CD4 T cell, and CD8 T cell in laparoscopic resection compared with open resection was observed [34]. In some studies exploring the inflammatory response differences among different surgical techniques, the immunologically beneficial IFN-γ, produced by the principal effectors of cell-mediated immunity Th1 cells, seemed to have a more active presence following laparoscopic colectomy, potentially contributing to an immunologic "advantage" by counteracting "harmful" cytokines, such as IL-1 [35,36]. Better preserved inflammatory function after surgery may reflect a reduction in operative trauma when the laparoscopic technique is compared with open procedures.…”

Section: Short-term Outcomesmentioning

confidence: 99%

Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery

Biondi¹,

Grosso

Mistretta

et al. 2013

BMC Surg

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BackgroundIn the late '80s the successes of the laparoscopic surgery for gallbladder disease laid the foundations on the modern use of this surgical technique in a variety of diseases. In the last 20 years, laparoscopic colorectal surgery had become a popular treatment option for colorectal cancer patients.DiscussionMany studies emphasized on the benefits stating the significant advantages of the laparoscopic approach compared with the open surgery of reduced blood loss, early return of intestinal motility, lower overall morbidity, and shorter duration of hospital stay, leading to a general agreement on laparoscopic surgery as an alternative to conventional open surgery for colon cancer. The reduced hospital stay may also decrease the cost of the laparoscopic surgery for colorectal cancer, despite th higher operative spending compared with open surgery. The average reduction in total direct costs is difficult to define due to the increasing cost over time, making challenging the comparisons between studies conducted during a time range of more than 10 years. However, despite the theoretical advantages of laparoscopic surgery, it is still not considered the standard treatment for colorectal cancer patients due to technical limitations or the characteristics of the patients that may affect short and long term outcomes.ConclusionsThe laparoscopic approach to colectomy is slowly gaining acceptance for the management of colorectal pathology. Laparoscopic surgery for colon cancer demonstrates better short-term outcome, oncologic safety, and equivalent long-term outcome of open surgery. For rectal cancer, laparoscopic technique can be more complex depending on the tumor location. The advantages of minimally invasive surgery may translate better care quality for oncological patients and lead to increased cost saving through the introduction of active enhanced recovery programs which are likely cost-effective from the perspective of the hospital health-care providers.

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Section: Short-term Outcomesmentioning

confidence: 99%

Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery

Biondi¹,

Grosso

Mistretta

et al. 2013

BMC Surg

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“…patients undergoing colectomy, systemic inflammation was significantly higher after an open approach than after a laparoscopic procedure, which is due to less trauma in the LC group [31][32][33][34] . Endotoxin is a potent stimulator of the release of cytokines such as IL-6 and tumor necrosis factor (TNF) [33,35,36] .…”

Section: Introductionmentioning

confidence: 99%

Systemic inflammation and immune response after laparotomyvslaparoscopy in patients with acute cholecystitis, complicated by peritonitis

Sista

Schietroma²,

Santis³

et al. 2013

WJGS

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AIM:To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach. METHODS:From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 ℃, leukocytosis greater than 10 × 10 9 /L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis, complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-operative day 6. RESULTS:The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC grou...

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“…3,4 Also, cellular immune responses appear to be less affected by laparoscopic colorectal resection compared with open resection as determined by total lymphocyte count, CD4 þ and CD8 þ T cells, interferon-c, and human leukocyte antigen-DR. [5][6][7][8] However, these differences are not consistent at all time intervals, and further studies are needed to fully characterize the importance of temporal changes in these markers. Furthermore, despite potential benefits, laparoscopic surgery still remains technically challenging in rectal cancer and will not be suitable for all patients.…”

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confidence: 99%

Surgical Stress Response After Colorectal Resection

Andersson

Ansari

Nordén

et al. 2013

International Surgery

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The human body's response to surgery is correlated with the extent of tissue damage. The aim of the present study was to, over time, map out parameters concerning inflammation, metabolism, nutrition, breathing function, muscle strength, and well-being in elective colorectal surgery. Eighteen patients were prospectively included: colon resection (n ¼ 9) and rectum resection/amputation (n ¼ 9). Postoperative interleukin 10 (IL-10) rose more in the rectum surgery group on day 0 (P ¼ 0.007) and day 3 (P ¼ 0.025). Furthermore, significant differences between groups were detected regarding albumin, prealbumin, and total iron-binding capacity (TIBC). For albumin and TIBC, this difference was seen even on day 7. C-reactive protein, IL-6, IL-8, glucose, cortisol, insulin, pain, fatigue, nausea, grip strength, and forced expiratory volume in 1 second did not show any differences. No correlation was revealed between measured parameters and postoperative complications. Postoperative levels of IL-10, albumin, prealbumin, and TIBC may be used as determinants of surgical stress after colorectal surgery.

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Systemic inflammatory response after laparoscopic and conventional colectomy for cancer: a matched case–control study

Cited by 28 publications

References 49 publications

Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery

Laparoscopic vs. open approach for colorectal cancer: evolution over time of minimal invasive surgery

Systemic inflammation and immune response after laparotomyvslaparoscopy in patients with acute cholecystitis, complicated by peritonitis

Surgical Stress Response After Colorectal Resection

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