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Postoperative lymphopenia: An independent risk factor for postoperative pneumonia after lung cancer surgery, results of a case-control study. PLoS One 2018; 13:e0205237. [PMID: 30321194 PMCID: PMC6188898 DOI: 10.1371/journal.pone.0205237] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 09/23/2018] [Indexed: 12/02/2022] Open
Abstract
Objective Postoperative lymphopenia has been proposed as a risk factor for postoperative infections but has never been identified as such in a multivariate analysis. Postoperative pneumonia (POP) is one of the most common complications after lung cancer surgery and is associated with a worse outcome. We aimed to evaluate the association between postoperative lymphopenia and POP after lung cancer surgery. Methods Patients admitted for lung cancer surgery (lobectomy, bilobectomy, or pneumonectomy) aged ≥ 18 years and with no history of an immunosuppressive state were eligible for inclusion. Lymphocyte counts were determined in blood drawn on the day before surgery and at postoperative days 1, 3 and 7. POP diagnosis was based on clinical, biological and radiological data. A logistic regression model adjusted on currently described risk factors for POP was used to explain the onset of this condition. Results Two hundred patients were included, of whom 43 (21.5%) developed POP. Preoperative lymphocyte count was 1.8±0.6x109 cells/L and 2.0±0.7x109 cells/L in patients with and without POP, respectively (P = .091). In both groups, the lymphocyte count nadir occurred at postoperative day 1. In multivariate analysis, lymphopenia at postoperative day 1 was significantly associated with increased risk of POP (odds ratio: 2.63, 95% CI [1.03–5.40]). POP rate at postoperative day 7 was higher in patients presenting low lymphocyte counts (≤1.19x109 cells/L) at postoperative day 1 (P = .003). Conclusions Our study showed that lymphopenia following lung cancer surgery was maximal at postoperative day 1 and was associated with POP.
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Alieva M, van Rheenen J, Broekman MLD. Potential impact of invasive surgical procedures on primary tumor growth and metastasis. Clin Exp Metastasis 2018; 35:319-331. [PMID: 29728948 PMCID: PMC6063335 DOI: 10.1007/s10585-018-9896-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023]
Abstract
Surgical procedures such as tumor resection and biopsy are still the gold standard for diagnosis and (determination of) treatment of solid tumors, and are prognostically beneficial for patients. However, growing evidence suggests that even a minor surgical trauma can influence several (patho) physiological processes that might promote postoperative metastatic spread and tumor recurrence. Local effects include tumor seeding and a wound healing response that can promote tumor cell migration, proliferation, differentiation, extracellular matrix remodeling, angiogenesis and extravasation. In addition, local and systemic immunosuppression impairs antitumor immunity and contributes to tumor cell survival. Surgical manipulation of the tumor can result in cancer cell release into the circulation, thus increasing the chance of tumor cell dissemination. To prevent these undesired effects of surgical interventions, therapeutic strategies targeting immune response exacerbation or alteration have been proposed. This review summarizes the current literature regarding these local, systemic and secondary site effects of surgical interventions on tumor progression and dissemination, and discusses studies that aimed to identify potential therapeutic approaches to prevent these effects in order to further increase the clinical benefit from surgical procedures.
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Affiliation(s)
- Maria Alieva
- Princess Máxima Center for Pediatric Oncology, Uppsalalaan 8, 3584 CT, Utrecht, The Netherlands.
| | - Jacco van Rheenen
- Department of Molecular Pathology, Oncode Institute, Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Marike L D Broekman
- Department of Neurology & Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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McIlvried LA, Cruz JA, Borghesi LA, Gold MS. Sex-, stress-, and sympathetic post-ganglionic-dependent changes in identity and proportions of immune cells in the dura. Cephalalgia 2016; 37:36-48. [PMID: 26970607 DOI: 10.1177/0333102416637832] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Aim of investigation Due to compelling evidence in support of links between sex, stress, sympathetic post-ganglionic innervation, dural immune cells, and migraine, our aim was to characterize the impacts of these factors on the type and proportion of immune cells in the dura. Methods Dural immune cells were obtained from naïve or stressed adult male and female Sprague Dawley rats for flow cytometry. Rats with surgical denervation of sympathetic post-ganglionic neurons of the dura were also studied. Results Immune cells comprise ∼17% of all cells in the dura. These included: macrophages/granulocytes ("Macs"; 63.2% of immune cells), dendritic cells (0.88%), T-cells (4.51%), natural killer T-cells (0.51%), natural killer cells (3.08%), and B-cells (20.0%). There were significantly more Macs and fewer B- and natural killer T-cells in the dura of females compared with males. Macs and dendritic cells were significantly increased by stress in males, but not females. In contrast, T-cells were significantly increased in females with a 24-hour delay following stress. Lastly, Macs, dendritic cells, and T-cells were significantly higher in sympathectomized-naïve males, but not females. Conclusions It may not only be possible, but necessary to use different strategies for the most effective treatment of migraine in men and women.
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Affiliation(s)
- Lisa A McIlvried
- 1 Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA, USA.,2 The Pittsburgh Center for Pain Research, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Agustin Cruz
- 3 Department of Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa A Borghesi
- 3 Department of Immunology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael S Gold
- 1 Center for Neuroscience at the University of Pittsburgh, Pittsburgh, PA, USA.,2 The Pittsburgh Center for Pain Research, University of Pittsburgh, Pittsburgh, PA, USA.,4 Department of Anesthesiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,5 Department of Neurobiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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Chen XF, Qian J, Pei D, Zhou C, Røe OD, Zhu F, He SH, Qian YY, Zhou Y, Xu J, Xu J, Li X, Ping GQ, Liu YQ, Wang P, Guo RH, Shu YQ. Prognostic value of perioperative leukocyte count in resectable gastric cancer. World J Gastroenterol 2016; 22:2818-2827. [PMID: 26973420 PMCID: PMC4778004 DOI: 10.3748/wjg.v22.i9.2818] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 11/19/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the prognostic significance of perioperative leukopenia in patients with resected gastric cancer.
METHODS: A total of 614 eligible gastric cancer patients who underwent curative D2 gastrectomy and adjuvant chemotherapy were enrolled in this study. The relationship between pre- and postoperative hematologic parameters and overall survival was assessed statistically, adjusted for known prognostic factors.
RESULTS: The mean white blood cell count (WBC) significantly decreased after surgery, and 107/614 (17.4%) patients developed p-leukopenia, which was defined as a preoperative WBC ≥ 4.0 × 109/L and postoperative WBC < 4.0 × 109/L, with an absolute decrease ≥ 0.5 × 109/L. The neutrophil count decreased significantly more than the lymphocyte count. P-leukopenia significantly correlated with poor tumor differentiation and preoperative WBC. A higher preoperative WBC and p-leukopenia were independent negative prognostic factors for survival [hazard ratio (HR) = 1.602, 95% confidence interval (CI): 1.185-2.165; P = 0.002, and HR = 1.478, 95%CI: 1.149-1.902; P = 0.002, respectively] after adjusting for histology, Borrmann type, pTNM stage, vascular or neural invasion, gastrectomy method, resection margins, chemotherapy regimens, and preoperative WBC count. The patients with both higher preoperative WBC and p-leukopenia had a worse prognosis compared to those with lower baseline WBC and no p-leukopenia (27.5 mo vs 57.3 mo, P < 0.001).
CONCLUSION: Preoperative leukocytosis alone or in combination with postoperative leukopenia could be independent prognostic factors for survival in patients with resectable gastric cancer.
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Immune responses following stereotactic body radiotherapy for stage I primary lung cancer. BIOMED RESEARCH INTERNATIONAL 2013; 2013:731346. [PMID: 24324972 PMCID: PMC3842068 DOI: 10.1155/2013/731346] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/15/2013] [Accepted: 09/20/2013] [Indexed: 11/20/2022]
Abstract
Purpose. Immune responses following stereotactic body radiotherapy (SBRT) for stage I non-small cell lung cancer (NSCLC) were examined from the point of view of lymphocyte subset counts and natural killer cell activity (NKA). Patients and Methods. Peripheral blood samples were collected from 62 patients at 4 time points between pretreatment and 4 weeks post-treatment for analysis of the change of total lymphocyte counts (TLC) and lymphocyte subset counts of CD3+, CD4+, CD8+, CD19+, CD56+, and NKA. In addition, the changes of lymphocyte subset counts were compared between patients with or without relapse. Further, the correlations between SBRT-related parameters and immune response were analyzed for the purpose of revealing the mechanisms of the immune response. Results. All lymphocyte subset counts and NKA at post-treatment and 1 week post-treatment were significantly lower than pre-treatment (P < 0.01). No significant differences in the changes of lymphocyte subset counts were observed among patients with or without relapse. The volume of the vertebral body receiving radiation doses of 3 Gy or more (VV3) significantly correlated with the changes of nearly all lymphocyte subset counts. Conclusions. SBRT for stage I NSCLC induced significant immune suppression, and the decrease of lymphocyte subset counts may be associated with exposure of the vertebral bone marrow.
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Grosek S, Petrin Z, Kopitar AN, Grosek J, Erzen J, Gmeiner TS, Petreska M, Primozic J, Ihan A. Low CD8 T cells in neonates and infants prior to surgery, and health-care-associated infections: prospective observational study. Pediatr Int 2013; 55:410-5. [PMID: 23701302 DOI: 10.1111/ped.12142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 02/17/2013] [Accepted: 03/12/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND Major surgery suppresses the cell-mediated immune response in children and adults. Data on preoperative and postoperative T-cell counts in pediatric surgical patients and their relationship to health-care-associated infection (HAI) are not yet known. METHODS A prospective observational study was carried out in a level III multidisciplinary neonatal and pediatric intensive care unit. Before and after, and in the first 3 days after surgery, lymphocyte subsets in peripheral blood were measured in 28 neonates and infants on flow cytometry. HAI were classified according to CDC/NHSN criteria. RESULTS Six out of 28 neonates and infants (21.4%) developed HAI (group I-HAI), while 22 out of 28 (78.6%) remained infection free (group II-non-HAI). In group I with HAI, the preoperative median cytotoxic T-lymphocyte (CD8-T-cell) level was found to be below normal, and remained very low throughout the study period. In addition, the median and interquartile CD8 T-cell range (358 cells/μL; 304-424 cells/μL) were twice as low compared to group II without HAI (822 cells/μL; 522-933 cells/μL; P = 0.013). No differences were found between the two groups with regard to patient demographics and clinical data. CONCLUSION Neonates and infants who underwent a major surgical procedure and who had a very low preoperative CD8 T-cell level, developed HAI postoperatively.
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Affiliation(s)
- Stefan Grosek
- Department of Pediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.
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Regulating surgical oncotaxis to improve the outcomes in cancer patients. Surg Today 2013; 44:804-11. [PMID: 23736890 DOI: 10.1007/s00595-013-0627-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Accepted: 04/30/2013] [Indexed: 01/16/2023]
Abstract
Excessive surgical stress and postoperative complications cause a storm of perioperative cytokine release, which has been shown to enhance tumor metastasis in experimental models. We have named this phenomenon "surgical oncotaxis". The mechanisms that underpin this process are thought to be excessive corticosteroid secretion, coagulopathy in the peripheral vasculature, immune suppression and excessive production of reactive oxygen species. Nuclear factor-kappa B (NFkB) activation plays a key role in these mechanisms. Minimally invasive surgical techniques should be used, and postoperative complications should be avoided whenever possible to lessen the impact of surgical oncotaxis. Furthermore, there may be a role for a small preoperative dose of corticosteroid or the use of free radical scavengers in the perioperative period. Recently, there has been a great deal of interest in omega-3 fatty acid, because it regulates NFkB activation. The use of multimodal treatments that regulate surgical oncotaxis may be as important as chemotherapy for determining the outcome of patients with cancer undergoing surgery.
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Wang X, Qin J, Chen J, Wang L, Chen W, Tang L. The effect of high-intensity focused ultrasound treatment on immune function in patients with uterine fibroids. Int J Hyperthermia 2013; 29:225-33. [PMID: 23537008 DOI: 10.3109/02656736.2013.775672] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to investigate the effect of high-intensity focused ultrasound (HIFU) on immune function in patients with uterine fibroids, in a randomised comparison to conventional myomectomy. METHODS The patients were assigned (1:1) to the HIFU group or the myomectomy (MY) group. Venous blood samples were collected 24 h before and 24 h and 72 h after operation. The percentages of CD4(+) and CD8(+) T cells and natural killer (NK) cells were quantified by flow cytometry (FCM). Serum levels of interleukin-2 (IL-2), IL-6 and IL-10 were determined using enzyme-linked immunosorbent assay. RESULTS HIFU was associated with early ambulation, fewer post-operative complications, and shorter hospital stay (p < 0.001). The percentages of CD4(+) and CD8(+) T cells and NK cells in the HIFU group were not significantly altered after treatment compared with before treatment. In contrast, the numbers of these cells in the MY group decreased significantly 24 h after conventional myomectomy (p < 0.001). The CD4(+)/CD8(+) T cell ratios were also decreased significantly 24 h and 72 h after conventional myomectomy (p < 0.001). Serum levels of IL-6 and IL-10 increased after treatment in both groups. Peak IL-6 and IL-10 levels were significantly lower in the HIFU group than in the MY group (p < 0.001). In contrast, IL-2 level decreased significantly in the MY group compared to the HIFU group at 24 h post-operation (p < 0.001). CONCLUSIONS Short-term post-operative immune function is better preserved after HIFU treatment. Better preserved immune function may reflect a reduction in tissue trauma after HIFU treatment and contribute to reduced post-operative complications.
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Affiliation(s)
- Xiaoyan Wang
- Department of Obstetrics and Gynaecology, First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Torres K, Torres A, Chrościcki A, Maciejewski R, Radej S, Roliński J, Pietrzyk Ł, Wallner G. Evaluation of lymphocytes CD4+ and CD8+ and expression of ZAP-70 kinase on CD3+ and CD19+ lymphocytes in obese patients undergoing laparoscopic cholecystectomy. Surg Endosc 2012; 27:872-9. [PMID: 23052508 PMCID: PMC3572373 DOI: 10.1007/s00464-012-2527-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Accepted: 07/24/2012] [Indexed: 11/06/2022]
Abstract
Background Obesity has become a global epidemic and a leading metabolic disease in the world. Laparoscopic surgeries may influence the function of the immunologic system. The percentages of CD4+ and CD8+ T lymphocyte cells have been described as prognostic factors for patients undergoing abdominal surgeries. This study aimed to evaluate the changes in CD4+ and CD8+ T lymphocyte cells, the ratio of CD4+ to CD8+ cells, and the ZAP-70 kinase expression on T CD3+ and B CD19+ cells in obese and normal-weight individuals undergoing laparoscopic cholecystectomy (LC). Methods The study group consisted of 46 asymptomatic patients with gallstones shown by ultrasound examination but without signs of any gallbladder complications. The patients underwent planned LC. Blood samples were obtained at three times, and the percentages of studied cells were measured by flow cytometry. Patients were enrolled to two groups: N group (body mass index [BMI], ≤25 kg/m2) and O group (BMI, ≥30 kg/m2). For statistical analysis, the Mann–Whitney U test and the Wilcoxon matched-pairs signed-ranks test were used. All p values lower than 0.05 were considered significant. Results The percentage of CD4+ T cells did not differ between the N and O groups before or after the surgery. Only in the N group did the percentage of CD4+ lymphocytes increase from 0 to 48 h. A higher percentage of CD8+ lymphocytes was observed in the O group postoperatively than in the N group. Differences of ZAP-70 kinase expression in the O group were observed at 24 and 48 h of the study. Decreased expression of ZAP-70 kinase was shown in the N group at both 0–24 and 24–48 h. In the O group, this tendency was noted at 24–48 h. Conclusions Immunologic activation after LC was confirmed in both weight groups. However, higher modulation, more typical for open surgeries, was observed in the obese group.
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Affiliation(s)
- Kamil Torres
- Laboratory of Biostructure, Human Anatomy Department, Medical University of Lublin, Jaczewskiego 4, 20-094 Lublin, Poland.
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Gao T, Li N, Zhang JJ, Xi FC, Chen QY, Zhu WM, Yu WK, Li JS. Restricted intravenous fluid regimen reduces the rate of postoperative complications and alters immunological activity of elderly patients operated for abdominal cancer: a randomized prospective clinical trail. World J Surg 2012; 36:993-1002. [PMID: 22402971 DOI: 10.1007/s00268-012-1516-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Perioperative fluid restriction can lead to better clinical outcomes and reduced complications. However, whether perioperative fluid restriction can alter the patient's postoperative cellular immunity is unknown. Therefore, a randomized, prospective clinical study was designed to determine whether fluid restriction improves immunological outcome in elderly patients who undergo gastrointestinal surgery for cancer removal. METHODS A total of 179 patients aged 65 years or older were recruited for the study and were randomly assigned to receive the restricted fluid regimen (R group) or the standard fluid regimen (S group). Postoperative T-lymphocyte subpopulations (CD3(+), CD4(+), and CD8(+)) frequencies and monocyte HLA-DR expression was investigated. Perioperative complications and cellular immunity changes were analyzed comparatively between the two groups. RESULTS The restricted intravenous fluid regimen was associated with significantly less postoperative complications (1.5 complications/patient vs. S group: 2.2 complications/patient), especially for infection complications (15% vs. S group: 27%, p = 0.04). Circulating CD3(+) T-cells were suppressed after surgery in both treatment groups, but the cell frequency (cell/μL) was higher in the R group (746 vs. S group: 480 at postoperative day (POD) 2, p = 0.022; 878 vs. 502 at POD 3, p = 0.005; 892 vs. 674 at POD 5, p = 0.042). Similarly, the HLA-DR expression (% of all T cells) in monocytes were decreased in both groups, but the expression remained higher in the R group (66.20 vs. S group: 51.97 at POD 1, p = 0.029; 68.19 vs. 51.26 at POD 2, p = 0.039; 72.19 vs. 57.45 at POD 3, p = 0.014; 73.92 vs. 60.46 at POD 5, p = 0.036). Multivariate analysis suggested that perioperative CD3(+) T cell changes were associated with the development of postoperative complications [odds ratio (OR) = 1.963; 95% confidence interval (CI) 1.019-3.782; p = 0.044] and postoperative infections (OR = 3.106; 95% CI 1.302-7.406; p = 0.011). CONCLUSIONS In elderly gastrointestinal cancer patients, cellular immunity is better preserved by the perioperative fluid restriction regimen. The better preserved cellular immunological function is correlated with a reduced perioperative complications rate.
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Affiliation(s)
- Tao Gao
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Ning Li
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Juan-Juan Zhang
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Feng-Chan Xi
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Qi-Yi Chen
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Wei-Ming Zhu
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
| | - Wen-Kui Yu
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China.
| | - Jie-Shou Li
- Department of General Surgery, Nanjing General Hospital of Nanjing Military Command Affiliated to Medical College of Nanjing University, Nanjing, 210002, Jiangsu Province, China
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Hogan BV, Peter MB, Shenoy HG, Horgan K, Hughes TA. Surgery induced immunosuppression. Surgeon 2010; 9:38-43. [PMID: 21195330 DOI: 10.1016/j.surge.2010.07.011] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2010] [Revised: 07/22/2010] [Accepted: 07/25/2010] [Indexed: 02/07/2023]
Abstract
Surgery and anaesthesia result in a variety of metabolic and endocrine responses, which result in a generalised state of immunosuppression in the immediate post-operative period. Surgery induced immunosuppression has been implicated in the development of post-operative septic complications and tumour metastasis formation. In addition the effectiveness of many treatments in the adjuvant setting is dependent on a functioning immune system. By understanding the mechanisms contributing to surgery-induced immunosuppression, surgeons may undertake strategies to minimise its effect and reduce potential short-term and long-term consequences to patients.
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Affiliation(s)
- Brian V Hogan
- Department of Surgery, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, United Kingdom.
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Perioperative host-tumor inflammatory interactions: A potential trigger for disease recurrence following a curative resection for colorectal cancer. Surg Today 2008; 38:579-84. [DOI: 10.1007/s00595-007-3674-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 10/23/2007] [Indexed: 12/20/2022]
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Jang Y, Song HK, Jeong DC, Lee SH. The effects of propofol and enflurane anesthesia on the proliferative responsiveness of peripheral blood mononuclear cells in culture as determined by the level of bromodeoxyuridine incorporation. Korean J Anesthesiol 2008. [DOI: 10.4097/kjae.2008.55.4.467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Yeon Jang
- Department of Anesthesiology, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Korea
| | - Ho Kyung Song
- Department of Anesthesiology, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Korea
| | - Dae Chul Jeong
- Department of Pediatrics, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Korea
| | - Seung-Hwan Lee
- Department of Anesthesiology, Incheon St. Mary's Hospital, The Catholic University of Korea, College of Medicine, Incheon, Korea
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Sylla P. Microarray Studies of Immune Function After Surgery. SEMINARS IN COLON AND RECTAL SURGERY 2007. [DOI: 10.1053/j.scrs.2007.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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15
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Bedalov G, Bartolin Z, Puskar D, Savić I, Bedalov I, Rudolf M, Batinić D. Differences in stress response between patients undergoing transurethral resection versus endoscopic laser ablation of the prostate for benign prostatic hyperplasia. Lasers Med Sci 2007; 23:65-70. [PMID: 17468896 DOI: 10.1007/s10103-007-0462-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 03/19/2007] [Indexed: 10/23/2022]
Abstract
The objective of the study was to determine the differences in systemic stress response in patients undergoing transurethral resection of the prostate (TURP) versus endoscopic laser ablation of the prostate (ELAP) for benign prostatic hyperplasia (BPH). The study included 48 patients with BPH (24 treated by TURP and 24 by ELAP). Blood samples were taken from each patient before and immediately after the procedure and on postoperative days 1, 6, and 20, respectively. TURP caused more intense acute-phase response during 24 h after the procedure considering the serum c-reactive protein (CRP) level (p < 0,001) and absolute leukocyte (p = 0.001) and neutrophil number (p = 0.003) in peripheral blood. ELAP caused more decrease in the number of natural killer cells immediately after the procedure (p = 0.048). There were no statistically significant differences between TURP and ELAP procedures in protein and creatine kinase (CK) levels, adrenocorticotropic hormone, and cortisol as well as other immunological parameters. TURP causes more intense acute-phase response than ELAP.
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Affiliation(s)
- Goran Bedalov
- Department of Urology, University Hospital Dubrava, Avenija Gojka Suska 6, 10000, Zagreb, Croatia.
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Abstract
Surgical trauma causes significant alterations in host immune function. Compared with open surgery, laparoscopic surgery is associated with reduced postoperative pain and more rapid return to normal activity. Experimental data have also shown more aggressive tumor establishment and growth rates following open surgery and laparoscopic surgery. Surgery-related immunosuppression may be partly responsible for the differences in cancer growth and outcome noted. It is clear that the choice of abdominal surgical approach has immunologic consequences. Further studies are needed to better the time course and extent of surgery-related alterations in the immune system and their clinical importance. A better understanding of the impact of surgery on the immune system may provide opportunities for pharmacologic manipulation of postoperative immune function to improve clinical results.
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Affiliation(s)
- Patricia Sylla
- Department of Surgery, College of Physicians and Surgeons of Columbia University, 630 West 168th Street, New York, NY 10032, USA
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Heinrich M, Belohradsky BH, Till H. Immune Response after Conventional and Minimally Invasive Surgery in Children: Lymphocyte Subpopulations and HLA-DR Expression on Monocytes. ACTA ACUST UNITED AC 2004. [DOI: 10.1089/109264104773513124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Shakhar G, Ben-Eliyahu S. Potential prophylactic measures against postoperative immunosuppression: could they reduce recurrence rates in oncological patients? Ann Surg Oncol 2004; 10:972-92. [PMID: 14527919 DOI: 10.1245/aso.2003.02.007] [Citation(s) in RCA: 239] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Removing the primary tumor is indispensable for eliminating the major pool of metastasizing cells, but the surgical procedure itself is suspected of promoting metastases. This adverse effect is attributed to several mechanisms acting in synergy, including mechanical release of tumor cells, enhanced angiogenesis, secretion of growth factors, and immunosuppression. Here we provide new insights into mechanisms of postoperative immunosuppression and assess the assumptions underlying the hypothesis that, by suppressing cell-mediated immunity (CMI), surgery may render the patient vulnerable to metastases that otherwise could have been controlled. METHODS An extensive review of relevant articles in English identified by using the MEDLINE database and cross-referencing. RESULTS Current literature suggests that (1) CMI can control minimal residual disease, especially if surgery is performed early; (2) major surgery transiently but markedly suppresses CMI through multiple mechanisms now better understood; (3) surgical stress promotes experimental metastasis through immunosuppression, but the clinical evidence remains indirect because of ethical limitations. CONCLUSIONS Minimizing postoperative immunosuppression seems feasible, may limit recurrence, and should be introduced into the broader array of considerations when planning oncological surgeries. In the short run, physicians could try to avoid immunosuppressive anesthetic approaches, inadvertent hypothermia, excessive blood transfusions, and untended postoperative pain. When feasible, minimally invasive surgery should be considered. In the long run, clinical trials should evaluate prophylactic measures, including perioperative immunostimulation and several antagonists to cytokines and hormones specified herein.
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Affiliation(s)
- Guy Shakhar
- Neuroimmunology Research Unit, Department of Psychology, Tel Aviv University, Tel Aviv, Israel
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Abstract
Laparoscopic radical nephrectomy has evolved tremendously over the past decade to the point where it should be considered the standard of care for localized renal tumors not amenable to nephron-sparing surgery. The benefits of decreased postoperative pain, shortened hospital stay, quicker convalescence, and improved cosmesis have been proved in numerous studies. Long-term oncologic results of LRN have demonstrated equivalent outcomes to ORN.
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Affiliation(s)
- Kenneth Ogan
- Department of Urology, Emory Medical Center, Emory Building, Clinic A Room 3211, 1365 Clifton Road NE, Atlanta, GA 30322, USA
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Altamura M, Tafaro A, Casale D, Pepe M, Colella R, Jirillo E, Venezia P. A comparative study between conventional and laparoscopic cholecystectomy: evaluation of phagocytic and T-cell-mediated antibacterial activities. J Clin Gastroenterol 2002; 34:135-40. [PMID: 11782606 DOI: 10.1097/00004836-200202000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Over the past few years, many reports have pointed out that open, but not minimally invasive, cholecystectomy was associated with reduced immune functions. Also, after laparoscopic surgery, a reduced impairment of T cell functions and lower levels of proinflammatory cytokines, epinephrine, and norepinephrine were found in comparison with those detected in patients who underwent conventional cholecystectomy. We investigated polymorphonuclear cell- and monocyte-mediated phagocytosis and killing and T-cell-mediated antibacterial activity in 12 patients who underwent open cholecystectomy versus another group of 12 patients who underwent laparoscopic cholecystectomy. Our data show that polymorphonuclear and monocyte killing activities are preserved or are less affected in patients who undergo laparoscopy when compared with patients who undergo conventional operation. On the other hand, in both groups of patients, T-cell-mediated antibacterial activity was significantly reduced in the preoperative period, and, therefore, we could not draw conclusions on the effects of the surgical techniques used on the above immune parameter. The overall data suggest that laparoscopic cholecystectomy is a valid alternative to open surgery because of the moderate postoperative immune suppression and decreased risk of postsurgical infections.
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Affiliation(s)
- Maria Altamura
- Department of Internal Medicine, Immunology, and Infectious Disease, University of Bari, Bari, Italy
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Abstract
BACKGROUND Laparoscopic surgery is believed to lessen surgical trauma and so cause less disturbance of immune function. This may contribute to the rapid recovery noted after many laparoscopic operations. Preservation of both systemic and intraperitoneal immunity is particularly important in surgery for sepsis or cancer and so an understanding of the impact of laparoscopy on immune function is relevant. METHODS Literature on immunological changes following laparoscopy and open surgery was identified from Medline, along with cross-referencing from the reference lists of major articles on the subject. RESULTS AND DISCUSSION Despite a few contradictory reports, systemic immunity appears to be better preserved after laparoscopic surgery than after open surgery. However, the local intraperitoneal immune system behaves in a particular way when exposed to carbon dioxide pneumoperitoneum; suppression of intraperitoneal cell-mediated immunity has been demonstrated in a number of studies. This feature may be clinically important and should be acknowledged when considering laparoscopic surgery in patients with malignancy or sepsis.
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Affiliation(s)
- A Gupta
- University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia
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Portis AJ, Elnady M, Clayman RV. Laparoscopic radical/total nephrectomy: a decade of progress. J Endourol 2001; 15:345-54; discussion 375-6. [PMID: 11394445 DOI: 10.1089/089277901300189330] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The first laparoscopic radical/total nephrectomy for a renal tumor was performed in June 1990. Since that time, the procedure has evolved as numerous surgeons have contributed novel strategies and technical advances. The state of the art is reviewed, including transperitoneal laparoscopic and hand-assisted techniques, as well as the retroperitoneal approach. Operative and postoperative data are reviewed with the goal of determining four factors: the efficacy, efficiency, morbidity, and cost of the procedure. Within the limits of available follow-up for this novel procedure, it appears to be as effective as open surgery in rendering the patient tumor free. Although it clearly is a less painful and less disabling procedure than open surgery, our understanding of the efficiency of the laparoscopic procedure remains in flux. The operative times for laparoscopic radical/total nephrectomy are approaching those of traditional open radical nephrectomy, although intraoperative costs remain higher and thus must be balanced against decreased hospitalization and convalescence.
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Affiliation(s)
- A J Portis
- Department of Surgery, Washington University School of Medicine, St Louis, Missouri 63110, USA
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Abstract
Since its inception in June 1990, laparoscopic radical/total nephrectomy for renal tumor has been successfully applied worldwide to hundreds of patients. Recent 5-year follow-up data have shown this procedure to produce cancer control identical to that of open radical/total nephrectomy. Although in most centers the cost of the procedure remains higher than open surgery, the patient benefits of decreased pain, reduced hospitalization, less blood loss, and more rapid convalescence appear to be universal. At this time, we believe that laparoscopic radical/total nephrectomy for the treatment of renal tumors should become the new standard of care.
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Affiliation(s)
- A J Portis
- Department of Surgery, Division of Urologic Surgery, Washington University School of Medicine, 4960 Children"s Place, St. Louis, MO 63110, USA
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Abstract
Although open nephrectomy is the standard of care for localized renal-cell carcinoma, the significant postoperative pain and lengthy convalescence have encouraged the use of laparoscopy, which can yield similar 2- to 5-year survival rates. Either a transperitoneal or a retroperitoneal approach may be used, and sometimes, they are combined. Generally, the technique is limited to tumors <10 cm, but larger tumors can be removed. Nitrous oxide is avoided as an anesthetic agent. The dissection follows accepted oncologic principles: in situ renal dissection within Gerota's fascia, early ligation of the renal vessels, and careful removal of the specimen to prevent tumor spillage. Dissection of the hilum is facilitated by a PEER retractor and an Endoholder. On average, patients having laparoscopic radical nephrectomy return to normal activities approximately 4.5 weeks sooner than those having open surgery, a fact not taken into account in cost analyses. Laparoscopic nephrectomy may offer a special benefit in patients with known metastatic disease, as interleukin-2 administration can be started a month earlier than after open surgery. There may also be immunologic benefits of minimally invasive v open surgery. The technique and instruments continue to evolve, and cost-effectiveness should continue to improve.
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Affiliation(s)
- M D Dunn
- Department of Urology, University of Southern California School of Medicine, Los Angeles, USA
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Dunn MD, Portis AJ, Shalhav AL, Elbahnasy AM, Heidorn C, McDougall EM, Clayman RV. LAPAROSCOPIC VERSUS OPEN RADICAL NEPHRECTOMY: A 9-YEAR EXPERIENCE. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67131-5] [Citation(s) in RCA: 286] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Matthew D. Dunn
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
| | - Andrew J. Portis
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
| | - Arieh L. Shalhav
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
| | - Abdelhamid M. Elbahnasy
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
| | - Cindy Heidorn
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
| | - Elspeth M. McDougall
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
| | - Ralph V. Clayman
- From the Departments of Surgery, Urology and Radiology, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, and Department of Urology, Tanta University, Tanta, Egypt
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Lausten SB, Ibrahim TM, El-Sefi T, Jensen LS, Gesser B, Larsen CG, Tønnesen E, Jensen SL. Systemic and cell-mediated immune response after laparoscopic and open cholecystectomy in patients with chronic liver disease. A randomized, prospective study. Dig Surg 2000; 16:471-7. [PMID: 10805546 DOI: 10.1159/000018772] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND As impaired immune function observed in cirrhotic patients is known to increase the risk of postoperative complications, the immunological response to surgery was investigated. METHODS Twenty-eight patients with postnecrotic liver cirrhosis or chronic hepatitis C and symptomatic gallstone disease were randomly allocated to laparoscopic (LC) or open cholecystectomy (OC). Changes in concentrations of cytokines (TNF-alpha, IL-1beta, IL-6, IL-8 and IL-10) were followed and the effect of surgical trauma on the distribution of lymphocyte subpopulations (CD3, CD4, CD8, CD16 and CD19) and NK cell cytotoxicity were measured. RESULTS After OC a decrease in circulating CD3 (p < 0.05) and CD4 (p < 0.05) and an increase in CD19 (p < 0.05) cells were detected in contrast to LC after which only CD16 cells decreased (p = 0.05). The number of CD3 cells was higher after LC than after OC (p < 0.01), whereas the number of CD19 cells was higher after OC than after LC (p < 0.01). NK cell cytotoxicity was reduced after LC (p < 0.05). In cirrhotic patients circulating cytokines were unaffected by OC, whereas TNF-alpha (p < 0.05) and IL-1beta (p < 0.05) were reduced after LC. In chronic hepatitis IL-1beta decreased after OC (p = 0.05) and IL-10 was significantly higher after LC than following OC (p < 0.05). CONCLUSION The immune response is less pronounced after a laparoscopic procedure compared to a conventional approach in patients with chronic liver disease.
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Affiliation(s)
- S B Lausten
- Department of Surgery, Aarhus University Hospital, Denmark.
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Abstract
BACKGROUND Immunosuppression associated with surgery may predispose to increased tumour growth or recurrence. Lymphocytes are central components of the immune network, signalling specific and non-specific responses in tumour immunosurveillance. This study was therefore designed to compare the effects of minimally invasive and conventional approaches to major thoracic surgery on lymphocyte populations and oxidative activity. PATIENTS AND METHODS The effects of conventional and minimally invasive video-assisted thoracic surgery (VATS) on the numbers and types of circulating lymphocytes and on lymphocyte oxidation were compared in a prospective randomized study of 41 patients undergoing lobectomy for peripheral bronchogenic carcinoma. Blood taken pre-operatively and on days 2 and 7 post-operatively was analysed for T (CD4, CD8), B (CD19) and natural killer (NK) (CD56, CD16) cell counts and for lymphocyte oxidative activity. Leucocyte numbers were compared with pre-surgical values and oxidative rate with healthy donor controls. RESULTS Lymphocyte counts fell after surgery; VATS was associated with less effect on circulating T (CD4) cells at 2 days and on NK lymphocytes at 7 days post-surgery. Lymphocyte oxidation was less suppressed in the VATS group 2 days after surgery. In general, post-surgical changes in key cells of cellular immunity were smaller in the VATS group, and recovery to normal levels was more rapid. CONCLUSION The degree of invasiveness of thoracic surgery may influence the extent of immunosuppression in patients undergoing pulmonary lobectomy for pulmonary neoplasm.
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Affiliation(s)
- H A Leaver
- Royal Infirmary of Edinburgh; University of Edinburgh, Edinburgh, UK
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Zieren J, Jacobi CA, Wenger FA, Volk HD, Müller JM. Fundoplication: a model for immunologic aspects of laparoscopic and conventional surgery. J Laparoendosc Adv Surg Tech A 2000; 10:35-40. [PMID: 10706301 DOI: 10.1089/lap.2000.10.35] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Immunologic investigations of laparoscopic and conventional procedures have recently been performed during cholecystectomy or colon resection, but the results might have been influenced by the amount of dissection or the presence of malignant tumor. Because fundoplication is characterized by moderate dissection and no resection, we supposed it to be an appropriate procedure for comparing immunologic changes during laparoscopic and conventional surgery. PATIENTS AND METHODS Immunologic analysis (interleukin [IL]-6, IL-10, leukocytes, HLA-DR monocytes) was carried out on the peripheral blood of 34 patients who underwent elective Nissen fundoplication by the laparoscopic (LAP; N = 26) or conventional (OPEN; N = 8) technique for gastroesophageal reflux disease. Blood samples were obtained before and 1 and 4 hours after the beginning of the operation and on days 1, 2, 4, 7 after the procedure. RESULTS A very fast and significant (P < 0.01) increase of the proinflammatory cytokines (IL-6, IL-10) and leukocytes and a decrease of cell-mediated functions (HLR-DR monocytes) were detected. Most of the analyzed measures had returned to preoperative values by 2 days after the procedure. All of the changes were similar in the two groups with the exception of IL-6. Throughout the post-operative study period, IL-6 concentrations were higher in the OPEN group, being significant 4 hours, 1 day, 2 days, and 4 days after the operation. CONCLUSION The investigation measures do not give evidence that laparoscopic fundoplication is superior to conventional fundoplication in its immunologic effects.
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Affiliation(s)
- J Zieren
- Department of Surgery, Charité, Humboldt University of Berlin, Germany.
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Trotter JF. Transient marked decrease in serum transaminases in chronic hepatitis C after surgery. Am J Gastroenterol 1999; 94:1988-90. [PMID: 10406287 DOI: 10.1111/j.1572-0241.1999.01988.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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