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Laparoscopically assisted colorectal surgery provides better short-term clinical and inflammatory outcomes compared to open colorectal surgery.

Janež J, Korać T, Kodre AR, Jelenc F, Ihan A - Arch Med Sci (2015)

Bottom Line: Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer.Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes.However, our results corroborate the results of previous studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia.

ABSTRACT

Introduction: Changes in immune function after surgery may influence overall outcome, length of hospital stay, susceptibility to infection and perioperative tumour dissemination in cancer patients. Our aim was to elaborate on postoperative differences in the immune status and the intensity of the systemic inflammatory response between two groups of prospectively enrolled patients with colorectal cancer, namely patients undergoing laparoscopically assisted or open colorectal surgery.

Material and methods: Blood samples from 77 patients were taken before surgery and then 3 h, 24 h and 4 days after surgery. The inflammatory response was determined by leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin levels (PCT). Immune status was determined by phenotypic analysis of lymphocyte populations and the activation of mononuclear cells. CD64 expression and cytokine expression were also determined.

Results: Patients undergoing laparoscopically assisted surgery had less intraoperative blood loss (p = 0.002), earlier resumption of diet (p = 0.002) and shorter hospital stay (p = 0.02). Numbers of total leukocytes (p = 0.12), CRP (p = 0.002) and PCT (p = 0.23) were remarkably higher 4 days after surgery in patients who underwent an open colorectal procedure. There was an important decrease in monocyte HLA-DR expression 3 h after surgery in patients undergoing laparoscopically assisted surgery (p = 0.03).

Conclusions: Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer. The acute inflammatory response is less pronounced. Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes. However, our results corroborate the results of previous studies.

No MeSH data available.


Related in: MedlinePlus

Mean response profiles for lymphocyte subpopulation levels at baseline (before surgery), after 3 h, 1 day and 4 days after surgery, OCS group (dashed black line) and LAS (grey line)
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Figure 0001: Mean response profiles for lymphocyte subpopulation levels at baseline (before surgery), after 3 h, 1 day and 4 days after surgery, OCS group (dashed black line) and LAS (grey line)

Mentions: The statistical language R was used to analyse the data (R version 3.0, R Foundation for Statistical Computing, Vienna, Austria). Mean values and standard deviations are reported. Differences between groups were tested by the Mann-Whitney test (♣) and mixed effect linear regression model (♠). Associations between categorical variables were tested by Fisher's exact test (♦). Primary hypotheses (results in Figure 1) were tested at the significance level 0.05 (*). The problem of multiple comparisons within secondary hypotheses was counteracted by testing at the significance level 0.01 (**).


Laparoscopically assisted colorectal surgery provides better short-term clinical and inflammatory outcomes compared to open colorectal surgery.

Janež J, Korać T, Kodre AR, Jelenc F, Ihan A - Arch Med Sci (2015)

Mean response profiles for lymphocyte subpopulation levels at baseline (before surgery), after 3 h, 1 day and 4 days after surgery, OCS group (dashed black line) and LAS (grey line)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697056&req=5

Figure 0001: Mean response profiles for lymphocyte subpopulation levels at baseline (before surgery), after 3 h, 1 day and 4 days after surgery, OCS group (dashed black line) and LAS (grey line)
Mentions: The statistical language R was used to analyse the data (R version 3.0, R Foundation for Statistical Computing, Vienna, Austria). Mean values and standard deviations are reported. Differences between groups were tested by the Mann-Whitney test (♣) and mixed effect linear regression model (♠). Associations between categorical variables were tested by Fisher's exact test (♦). Primary hypotheses (results in Figure 1) were tested at the significance level 0.05 (*). The problem of multiple comparisons within secondary hypotheses was counteracted by testing at the significance level 0.01 (**).

Bottom Line: Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer.Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes.However, our results corroborate the results of previous studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Abdominal Surgery, University Medical Centre, Ljubljana, Slovenia.

ABSTRACT

Introduction: Changes in immune function after surgery may influence overall outcome, length of hospital stay, susceptibility to infection and perioperative tumour dissemination in cancer patients. Our aim was to elaborate on postoperative differences in the immune status and the intensity of the systemic inflammatory response between two groups of prospectively enrolled patients with colorectal cancer, namely patients undergoing laparoscopically assisted or open colorectal surgery.

Material and methods: Blood samples from 77 patients were taken before surgery and then 3 h, 24 h and 4 days after surgery. The inflammatory response was determined by leukocyte counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and procalcitonin levels (PCT). Immune status was determined by phenotypic analysis of lymphocyte populations and the activation of mononuclear cells. CD64 expression and cytokine expression were also determined.

Results: Patients undergoing laparoscopically assisted surgery had less intraoperative blood loss (p = 0.002), earlier resumption of diet (p = 0.002) and shorter hospital stay (p = 0.02). Numbers of total leukocytes (p = 0.12), CRP (p = 0.002) and PCT (p = 0.23) were remarkably higher 4 days after surgery in patients who underwent an open colorectal procedure. There was an important decrease in monocyte HLA-DR expression 3 h after surgery in patients undergoing laparoscopically assisted surgery (p = 0.03).

Conclusions: Our study suggests that minimally invasive surgery provides better short-term clinical outcomes for patients with resectable colorectal cancer. The acute inflammatory response is less pronounced. Post-surgical immunological disturbance in both groups is similar, but we observed a divergent effect of different surgical approaches on the expression of HLA-DR on monocytes. However, our results corroborate the results of previous studies.

No MeSH data available.


Related in: MedlinePlus