LAPAROSCOPIC-ASSISTED VS. OPEN SURGERY FOR COLORECTAL-CANCER - COMPARATIVE-STUDY OF IMMUNE EFFECTS

PURPOSE: Our aim was to test the hypothesis that laparoscopic-assisted resection for colorectal cancer has an immunologic advantage over tra ditional open surgery. METHODS: Sixteen patients with colorectal cance r were randomized to undergo laparoscopic-assisted resection or open s urgery. Basic patient data were recorded, and serum interleukin-6 leve ls, relative proportions of lymphocytes, and human leukocyte antigen-D R expression on monocytes were determined at specific time intervals. RESULTS: Operating time was longer for laparoscopic-assisted resection (P = 0.02), but analgesic requirements were less (P = 0.04). All pati ents exhibited the following interleukin-6 levels increased to a maxim um at 4 hours and returned to preoperative levels within 48 hours. Thi s response appeared greater for open resection (mean peak level, 313 v s: 173 pg/ml;P = 0.25). Relative granulocytosis (P < 0.001) was seen w ithin 48 hours, which was offset by a decrease in percentage of lympho cytes (P < 0.001). Changes in lymphocyte subfractions were most signif icant seven days postsurgery : natural killer cells decreased (P = 0.0 03); T cells increased (P = 0.008), with elevation in the CD4/CD8 rati o (P = 0.003). B cells were largely unchanged at all time periods. Hum an leukocyte antigen-DR expression on monocytes was significantly less at 48 hours postsurgery (P <: 0.001). All changes were reversed withi n three weeks of surgery. There were no differences when comparing lap aroscopic-assisted resection with open surgery. CONCLUSIONS: Both lapa roscopic-assisted resection and open surgery affect the immune respons e. It would appear that laparoscopic-assisted resection does not have an immunologic advantage over open surgery in patients with colorectal cancer.