Immunologic and Oncologic Implications of Laparoscopic Surgery: What Is the Latest?

ABSTRACT

Laparoscopic surgery has been associated with many short-term benefits such as a shorter time to recovery, return of bowel function, less pain, and a decrease in wound infection rate. Several animal and human experiments have demonstrated an immunologic and oncologic benefit of minimally invasive surgery. Whether these results will translate into similar results in human settings is unclear. Although the first published prospective randomized clinical trial suggests better long-term outcomes for patients undergoing laparoscopic surgery, results from other ongoing randomized, controlled clinical trials are needed to verify this controversial result.

KEYWORDS

Laparoscopy - immunology - oncology

REFERENCES

• 1 Lacy A M, Garcia-Valdecasas J C, Delgado S et al.. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial.  Lancet. 2002;  359 2224-2229
• 2 Clinical Outcomes of Surgical Therapy Study Group . A comparison of laparoscopically assisted and open colectomy for colon cancer.  N Engl J Med. 2004;  350 2050-2059
• 3 Veldkamp R, Kuhry E, Hop W C et al.. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of randomized trial.  Lancet Oncol. 2005;  6 477-484
• 4 Fisher B. The evolution of paradigms for the management of breast cancer: a personal perspective.  Cancer Res. 1992;  52 2371-2383 , [Erratum, Cancer Res 1992;52:3512]
• 5 Allendorf J D, Bessler M, Kayton M L et al.. Increased tumor establishment and growth after laparotomy vs laparoscopy in a murine model.  Arch Surg. 1995;  130 649-653
• 6 Southall J C, Lee S W, Allendorf J D, Bessler M, Whelan R L. Colon adenocarcinoma and B-16 melanoma grow larger following laparotomy vs. pneumoperitoneum in a murine model.  Dis Colon Rectum. 1998;  41 564-569
• 7 Lee S W, Gleason N, Blanco I, Asi Z K, Whelan R L. Higher colon cancer tumor proliferative index and lower tumor cell death rate in mice undergoing laparotomy versus insufflation.  Surg Endosc. 2002;  16 36-39
• 8 Trokel M J, Bessler M, Treat M R, Whelan R L, Nowygrod R. Preservation of immune response after laparoscopy.  Surg Endosc. 1994;  8 1385-1388
• 9 Allendorf J DF, Bessler M, Whelan R L et al.. Better preservation of immune function after laparoscopic-assisted vs open bowel resection in a murine model.  Dis Colon Rectum. 1996;  39(suppl 10) 567-572
• 10 Kloosterman T, von Blomberg M E, Borgstein P, Cuesta M A, Scheper R J, Meijer S. Unimpaired immune functions after laparoscopic cholecystectomy.  Surgery. 1994;  115 424-428
• 11 Whelan R L, Franklin M, Hobar S D et al.. Postoperative cell mediated immune response is better preserved after laparoscopic versus open colorectal resection in humans.  Surg Endosc. 2003;  17 972-978
• 12 Christou N V, Meakins J L, MacLean L D. The predictive role of delayed hypersensitivity in preoperative patients.  Surg Gynecol Obstet . 1981;  152 297-301
• 13 Hershman M J, Cheadle W G, Wellhausen S R, Davidson P F, Polk Jr H C. Monocyte HLA-DR antigen expression characterizes clinical outcome in the trauma patient.  Br J Surg. 1990;  77 204-207
• 14 Decker D, Schondorf M, Bidlingmaier F, Hirner A, Von Ruecker A A. Surgical stress induces a shift in the type-1/type-2 T-helper cell balance, suggesting down regulation of cell mediated and up-regulation of antibody-mediated immunity commensurate to the trauma.  Surgery. 1996;  119 316-325
• 15 Bolla G, Tuzzato G. Immunologic postoperative competence after laparoscopy versus laparotomy.  Surg Endosc. 2003;  17 1247-1250 , [Epub ahead of print]
• 16 Klava A, Windsor A, Boylston A W, Reynolds J V, Ramsden C W, Guillou P J. Monocyte activation after open and laparoscopic surgery.  Br J Surg. 1997;  84 1152-1156
• 17 Brune I B, Wilke W, Hensler T, Feussner H, Holzmann B, Siewert J R. Normal T lymphocyte and monocyte function after minimally invasive surgery.  Surg Endosc. 1998;  12 1020-1024
• 18 Lee S W, Feingold D L, Carter J J et al.. Peritoneal macrophage and blood monocyte functions after open and laparoscopic-assisted cecectomy in rats.  Surg Endosc. 2003;  17 1996-2002
• 19 Horgan P G, Fitzpatrick M, Couse N F et al.. Laparoscopy is less immunotraumatic than laparotomy.  Minim Invasive Ther. 1992;  1 241-244
• 20 Lee S W, Southall J C, Gleason N R, Huang E H, Bessler M, Whelan R L. Time course of differences in lymphocyte proliferation rates after laparotomy vs CO₂ insufflation.  Surg Endosc. 2000;  14 145-148
• 21 Griffith J P, Everitt N J, Lancaster F et al.. Influence of laparoscopic and conventional cholecystectomy upon cell-mediated immunity.  Br J Surg. 1995;  82 677-680
• 22 Vallina V L, Velasco J M. The influence of laparoscopy on lymphocyte subpopulations in the surgical patient.  Surg Endosc. 1996;  10 481-484
• 23 Hansbrough J F, Bender E M, Zapata-Sirvent R, Anderson J. Altered helper and suppressor lymphocyte populations in surgical patients: a measure of postoperative immunosuppression.  Am J Surg. 1984;  148 303-307
• 24 Fujii K, Sonoda K, Izumi K, Shiraishi N, Adachi Y, Kitano S. T lymphocyte subsets and Th1/Th2 balance after laparoscopy-assisted distal gastrectomy.  Surg Endosc. 2003;  17 1440-1444 , [Epub ahead of print]
• 25 Iwanaka T, Arkovitz M S, Arya G, Ziegler M M. Evaluation of operative stress and peritoneal macrophage function in minimally invasive operations.  J Am Coll Surg. 1997;  184 357-363
• 26 Redmond H P, Watson W G, Houghton T, Condron C, Watson R GK, Boucher-Hayes D. Immune function in patients undergoing open vs. laparoscopic cholecystectomy.  Arch Surg. 1994;  129 1240-1246
• 27 Watson R W, Redmond H P, McCarthy J, Burke P E, Hayes D B. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model.  Br J Surg. 1995;  82 1060-1065
• 28 Hanna N, Burton R. Definitive evidence that natural killer (NK) cells inhibit experimental tumor metastases in vivo.  J Immunol. 1981;  127 1754-1759
• 29 Barlozzari T, Leonhardt J, Wiltrout R H, Herberman R B, Reynolds C W. Direct evidence for the role of LGL in the inhibition of experimental tumor metastases.  J Immunol. 1985;  134 2783-2789
• 30 Wiltrout R, Herberman R, Zhang S R et al.. Role of organ-associated NK cells in decreased formation of experimental metastases in lung and liver.  J Immunol. 1985;  134 4267-4273
• 31 Pollock R E, Lotzova E, Stanford S D, Rhomsdahl M M. Effect of surgical stress on murine natural killer cell cytotoxicity.  J Immunol. 1987;  138 171-178
• 32 Hewitt P M, Ip S M, Kwok S P et al.. Laparoscopic-assisted vs open surgery for colorectal cancer: comparative study of immune effects.  Dis Colon Rectum. 1998;  41 901-909
• 33 Da Costa M L, Redmond P, Bouchier-Hayes D J. The effect of laparotomy and laparoscopy on the establishment of spontaneous tumor metastases.  Surgery. 1998;  124 516-525
• 34 Da Costa M L, Redmond H P, Finnegan N, Flynn M, Bouchier-Hayes D. Laparotomy and laparoscopy differentially accelerate experimental flank tumour growth.  Br J Surg. 1998;  85 1439-1442
• 35 Lee S W, Gleason N R, Southall J C et al.. A serum-soluble factor(s) stimulates tumor growth following laparotomy in a murine model.  Surg Endosc. 2000;  14 490-494
• 36 Lee S W, Gleason N R, Stapleton G S et al.. Increased platelet-derived growth factor (PDGF) release after laparotomy stimulates systemic tumor growth in mice.  Surg Endosc. 2001;  15 981-985
• 37 Kirman I, Cekic V, Poltaratskaia N et al.. Plasma from patients undergoing major open surgery stimulates in vitro tumor growth: lower insulin-like growth factor binding protein 3 levels may, in part, account for this change.  Surgery. 2002;  132 186-192