Download PDF
Clin Colon Rectal Surg 2006; 19(1): 005-012
DOI: 10.1055/s-2006-939525
Copyright © 2006 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

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

Sang W. Lee2 , Richard L. Whelan1
  • 1Department of Surgery, New York Presbyterian Hospital of Columbia University, New York, New York
  • 2Weill Medical College of Cornell University, New York, New York
Further Information

Publication History

Publication Date:
07 April 2006 (online)

    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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]
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 15 Bolla G, Tuzzato G. Immunologic postoperative competence after laparoscopy versus laparotomy.  Surg Endosc. 2003;  17 1247-1250 , [Epub ahead of print]
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 19 Horgan P G, Fitzpatrick M, Couse N F et al.. Laparoscopy is less immunotraumatic than laparotomy.  Minim Invasive Ther. 1992;  1 241-244
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 22 Vallina V L, Velasco J M. The influence of laparoscopy on lymphocyte subpopulations in the surgical patient.  Surg Endosc. 1996;  10 481-484
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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]
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 28 Hanna N, Burton R. Definitive evidence that natural killer (NK) cells inhibit experimental tumor metastases in vivo.  J Immunol. 1981;  127 1754-1759
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Sang W LeeM.D. 

New York Presbyterian Hospital

525 East 68th St., Box 172, New York, NY 10021

Email: sal2013@med.cornell.edu

      >