Inflammatory response in laparoscopic vs. open surgery for gastric cancer

TY - JOUR

T1 - Inflammatory response in laparoscopic vs. open surgery for gastric cancer

AU - Okholm, Cecilie

AU - Goetze, Jens Peter

AU - Svendsen, Lars Bo

AU - Achiam, Michael Patrick

PY - 2014/9

Y1 - 2014/9

N2 - OBJECTIVE: Laparoscopic surgery may offer advantages compared to open surgery, such as earlier mobilization, less pain and lower post-surgical morbidity. Surgical stress is thought to be associated with the postoperative immunological changes in the body as an impaired immune function, which may lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer.METHODS: We conducted a literature search identifying relevant studies comparing laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters.RESULTS: We identified seven studies that addressed the immunological status in patients undergoing laparoscopic or laparoscopy-assisted surgery compared to open surgery. IL-6 in circulation was found to be significantly reduced in laparoscopic patients. Furthermore, the plasma concentration of C-reactive protein was significantly lower in laparoscopic patients compared to patients undergoing laparotomy. Finally, most studies reported lower levels of white blood cell count in laparoscopic patients, although this result did not reach statistical significance in a small number of studies.CONCLUSIONS: Laparoscopy-assisted gastric surgery seems to attenuate the immune response compared to open surgery. Larger and prospective studies are needed to further evaluate if the immunological status is relatively preserved in minimal invasive surgery and if this may reduce the postoperative complications compared to open surgery.

AB - OBJECTIVE: Laparoscopic surgery may offer advantages compared to open surgery, such as earlier mobilization, less pain and lower post-surgical morbidity. Surgical stress is thought to be associated with the postoperative immunological changes in the body as an impaired immune function, which may lead to an increased susceptibility to complications and morbidity. The aim of this review was to investigate if laparoscopic surgery reduces the immunological response compared to open surgery in gastric cancer.METHODS: We conducted a literature search identifying relevant studies comparing laparoscopy or laparoscopic-assisted surgery with open gastric surgery. The main outcome was postoperative immunological status defined as surgical stress parameters, including inflammatory cytokines and blood parameters.RESULTS: We identified seven studies that addressed the immunological status in patients undergoing laparoscopic or laparoscopy-assisted surgery compared to open surgery. IL-6 in circulation was found to be significantly reduced in laparoscopic patients. Furthermore, the plasma concentration of C-reactive protein was significantly lower in laparoscopic patients compared to patients undergoing laparotomy. Finally, most studies reported lower levels of white blood cell count in laparoscopic patients, although this result did not reach statistical significance in a small number of studies.CONCLUSIONS: Laparoscopy-assisted gastric surgery seems to attenuate the immune response compared to open surgery. Larger and prospective studies are needed to further evaluate if the immunological status is relatively preserved in minimal invasive surgery and if this may reduce the postoperative complications compared to open surgery.

KW - C-Reactive Protein

KW - Gastrectomy

KW - Humans

KW - Immune System Processes

KW - Inflammation

KW - Interleukin-6

KW - Laparoscopy

KW - Leukocyte Count

KW - Stomach Neoplasms

U2 - 10.3109/00365521.2014.917698

DO - 10.3109/00365521.2014.917698

M3 - Review

C2 - 24852697

SN - 0036-5521

VL - 49

SP - 1027

EP - 1034

JO - Scandinavian Journal of Gastroenterology

JF - Scandinavian Journal of Gastroenterology

IS - 9

ER -