Changes in T cell subsets, interleukin-6, and C-reactive protein after laparoscopic and open colorectal resection for malignancy

Background: Attenuation of the immune response to Surgery, as demonstrated with the laparoscopic approach to cholecystectomy, has potential benefits i n patients undergoing laparoscopic colonic resection for malignancy. We aim ed to study the perioperative immune response in patients undergoing laparo scopically assisted and open surgery for colorectal cancer. Methods: This study involved 23 patients undergoing laparoscopically assist ed (n=13) and open surgery (n=10). Interleukin-6 (IL-6) C-reactive protein (CRP), the total lymphocyte count, and the CD3, CD4, CD8, CD16, and CD19 ly mphocyte subpopulations were assayed preoperatively and at 4, 8, 10, 24, 48 , and 168 h postoperatively. Results: Significant rises in IL-6 and CRP were demonstrated within 4 and 2 4 h, respectively (p<0.001) in both groups. However, no significant differe nce between the groups was seen. Significant decreases in total lymphocyte count and all T cell subsets were demonstrated in both groups, beginning at 4 h (p<0.01). However, no significant difference between the groups was se en. All parameters, excluding CRP, had returned to baseline by 7 days posto peratively in both groups. Conclusions: Patients with malignancy exhibit significant perioperative imm une disturbance with laparoscopically assisted and open surgery. The curren t data do not provide justification for the laparoscopically assisted appro ach on grounds of immune preservation.