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Inflammatory and tumor stimulating responses after laparoscopic sigmoidectomy.

Kim JS, Hur H, Min BS, Lee KY, Chung HC, Kim NK - Yonsei Med. J. (2011)

Bottom Line: However, objective evidence of its immunologic and oncologic benefits is scarce.Clinical parameters and serum markers were compared.However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.

ABSTRACT

Purpose: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation.

Materials and methods: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared.

Results: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups.

Conclusion: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.

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The flow chart of patient selection process.
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Figure 1: The flow chart of patient selection process.

Mentions: A total of 81 patients were recruited in this study. Nine patients with immunosuppressant medication, distant metastasis, and transfusion were excluded. Two patients had anastomotic leakage, and one patient had tumor perforation at the time of surgery. Twelve patients were excluded because their samples were found to be inappropriate for ELISA test during the collection process. As a result, we enrolled 57 patients in the study. A flow chart of patient selection is described in Fig. 1. Nineteen patients received open surgery, and 38 patients received laparoscopic surgery. The two groups were comparable in terms of age, gender, body mass index, preoperative peripheral neutrophil count, preoperative CEA level, preoperative morbidity, and the American Society of Anesthesiologists score. However, the mean operation time was significantly longer in the laparosopic surgery group, whereas postoperative hospital stay, the first day of gas out, and the first day of soft diet were significantly shorter and earlier in the laparoscopic surgery group compared to the open surgery group. A summary of patient characteristics comparing open and laparoscopic surgeries is shown in Table 1.


Inflammatory and tumor stimulating responses after laparoscopic sigmoidectomy.

Kim JS, Hur H, Min BS, Lee KY, Chung HC, Kim NK - Yonsei Med. J. (2011)

The flow chart of patient selection process.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3104449&req=5

Figure 1: The flow chart of patient selection process.
Mentions: A total of 81 patients were recruited in this study. Nine patients with immunosuppressant medication, distant metastasis, and transfusion were excluded. Two patients had anastomotic leakage, and one patient had tumor perforation at the time of surgery. Twelve patients were excluded because their samples were found to be inappropriate for ELISA test during the collection process. As a result, we enrolled 57 patients in the study. A flow chart of patient selection is described in Fig. 1. Nineteen patients received open surgery, and 38 patients received laparoscopic surgery. The two groups were comparable in terms of age, gender, body mass index, preoperative peripheral neutrophil count, preoperative CEA level, preoperative morbidity, and the American Society of Anesthesiologists score. However, the mean operation time was significantly longer in the laparosopic surgery group, whereas postoperative hospital stay, the first day of gas out, and the first day of soft diet were significantly shorter and earlier in the laparoscopic surgery group compared to the open surgery group. A summary of patient characteristics comparing open and laparoscopic surgeries is shown in Table 1.

Bottom Line: However, objective evidence of its immunologic and oncologic benefits is scarce.Clinical parameters and serum markers were compared.However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yonsei University College of Medicine, 250 Seongsan-ro, Seodaemun-gu, Seoul 120-752, Korea.

ABSTRACT

Purpose: Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation.

Materials and methods: A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared.

Results: Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups.

Conclusion: Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.

Show MeSH
Related in: MedlinePlus