Journal Article

Immunologic Response After Laparoscopic Colon Cancer Operation Within an Enhanced Recovery Program

Li, Guoli, Jiang, Zhiwei, Wang, Gang, Pan, Huafeng, Li, Jieshou, Liu, Fengtao, Zhao, Kun

2012

Overview

Objective It has been demonstrated that colon operation combined with fast-track (FT) surgery and laparoscopic technique can shorten the length of hospital stay, accelerate recovery of intestinal function, and reduce the occurrence of post-operative complications. However, there are no reports regarding the combined effects of FT colon operation and laparoscopic technique on humoral inflammatory cellular immunity. Methods This was a prospective, controlled study. One hundred sixty-three colon cancer patients underwent the traditional protocol and open operation (traditional open group, n  = 42), the traditional protocol and laparoscopic operation (traditional laparoscopic group, n  = 40), the FT protocol and open operation (FT open group, n  = 41), or the FT protocol and laparoscopic operation (FT laparoscopic group, n  = 40). Blood samples were taken prior to operation as well as on days 1, 3, and 5 after operation. The number of lymphocyte subpopulations was determined by flow cytometry, and serum interleukin-6 and C-reactive protein levels were measured. Post-operative hospital stay, post-operative morbidity, readmission rate, and in-hospital mortality were recorded. Results Compared with open operation, laparoscopic colon operation effectively inhibited the release of post-operative inflammatory factors and yielded good protection via post-operative cell immunity. FT surgery had a better protective role with respect to the post-operative immune system compared with traditional peri-operative care. Inflammatory reactions, based on interleukin-6 and C-reactive protein levels, were less intense following FT laparoscopic operation compared to FT open operation; however, there were no differences in specific immunity (CD3+ and CD4+ counts, and the CD4+/CD8+ ratio) during these two types of surgical procedures. Post-operative hospital stay in patients randomized to the FT laparoscopic group was significantly shorter than in the other three treatment groups ( P  < 0.01). Post-operative complications in patients who underwent FT laparoscopic treatment were less than in the other three treatment groups ( P  < 0.05). There were no significant differences between the four treatment groups regarding readmission rate and in-hospital mortality. Conclusions The laparoscopic technique and FT surgery rehabilitation program effectively inhibited release of post-operative inflammatory factors with a reduction in peri-operative trauma and stress, which together played a protective role on the post-operative immune system. Combining two treatment measures during colon operation produced better protective effects via the immune system. The beneficial clinical effects support that the better-preserved post-operative immune system may also contribute to the improvement of post-operative results in FT laparoscopic patients.

• Publisher: Springer-Verlag,Springer Nature B.V
• Subject: Adult / Aged / Biomarkers - blood / C-reactive protein / C-Reactive Protein - metabolism / CD3 antigen / CD4 antigen / CD8 antigen / Chemotherapy / Colectomy - methods / Colectomy - mortality / Colectomy - rehabilitation / Colon / Colon cancer / Colonic Neoplasms - immunology / Colonic Neoplasms - mortality / Colonic Neoplasms - surgery / Colorectal cancer / Cytokines / Female / Flow Cytometry / Gastroenterology / Hospital Mortality / Hospitals / Humans / Immune system / Immunity / Immunity (cell-mediated) / Immunity, Humoral / Inflammation / Interleukin 6 / Interleukin-6 - blood / Intestine / Laparoscopy / Laparoscopy - mortality / Laparoscopy - rehabilitation / Length of stay / Length of Stay - statistics & numerical data / Lymphocyte Count / Lymphocytes / Male / Medicine / Medicine & Public Health / Metastasis / Middle Aged / Morbidity / Mortality / Original Article / Patient Readmission - statistics & numerical data / Perioperative Care - methods / Postoperative Complications - epidemiology / Prospective Studies / Radiation therapy / Rehabilitation / Stress / Surgery / Trauma / Treatment Outcome