Yonsei Med J.  2011 Jul;52(4):635-642. 10.3349/ymj.2011.52.4.635.

Inflammatory and Tumor Stimulating Responses after Laparoscopic Sigmoidectomy

• Kim JS
• Hur H
• Min BS
• Lee KY
• Chung HC
• Kim NK

• KMID: 1727997
• DOI: http://doi.org/10.3349/ymj.2011.52.4.635

Abstract

PURPOSE
Laparoscopic colectomy has clinical benefits such as short hospital stay, less postoperative pain, and early return of bowel function. However, objective evidence of its immunologic and oncologic benefits is scarce. We compared functional recovery after open versus laparoscopic sigmoidectomy and investigated the effect of open versus laparoscopic surgery on acute inflammation as well as tumor stimulation.
MATERIALS AND METHODS
A total of 57 patients who were diagnosed with sigmoid colon cancer were randomized for elective conventional or laparoscopically assisted sigmoidectomy. Serum samples were obtained preoperatively and on postoperative day 1. C-reactive protein (CRP) and interleukin-6 (IL-6) were measured as inflammation markers, and vascular endothelial growth factor (VEGF) and insulin-like growth factor binding protein-3 (IGFBP-3) were used as tumor stimulation factors. Clinical parameters and serum markers were compared.
RESULTS
Postoperative hospital stay (p=0.031), the first day of gas out (p=0.016), and the first day of soft diet (p<0.001) were significantly shorter for the laparoscopic surgery group than the open surgery group. The levels of CRP, IL-6, and VEGF rose significantly, and the concentration of IGFBP-3 fell significantly after both open and laparoscopic surgery. However, there were no significant differences in the preoperative and postoperative levels of CRP, IL-6, VEGF, and IGFBP-3 between the two groups.
CONCLUSION
Our data suggest that both open and laparoscopic surgeries are accompanied by significant changes in IL-6, CRP, IGFBP-3, and VEGF levels. Acute inflammation markers and tumor stimulating factors may not reflect clinical benefits of laparoscopic surgery.

Keyword

Colon neoplasm; laparoscopic surgery; acute inflammation; tumor stimulation

MeSH Terms

Aged
Biological Markers/blood
C-Reactive Protein/metabolism
Colectomy/*adverse effects/methods
Female
Humans
Inflammation/etiology/metabolism
Insulin-Like Growth Factor Binding Protein 3/blood
Interleukin-6/blood
Laparoscopy/adverse effects
Male
Middle Aged
Postoperative Period
Sigmoid Neoplasms/*surgery
Treatment Outcome
Vascular Endothelial Growth Factor A/blood

Figure

• 

  Fig. 1 The flow chart of patient selection process.

• 

  Fig. 2 Changes in the serum concentration of C-reactive protein (CRP) in patients undergoing open or laparoscopic surgery for sigmoid colon cancer. No significant differences were found between the open and laparoscopic surgery groups. *p<0.001 Preoperative (Preop) value versus the first postoperative day (POD1).

• 

  Fig. 3 Changes in the serum concentration of interleukin-6 (IL-6) in patients undergoing open or laparoscopic surgery for sigmoid colon cancer. No significant differences were found between the open and laparoscopic surgery groups. *p<0.001 Preoperative (Preop) value versus the first postoperative day (POD1).

• 

  Fig. 4 Changes in the serum concentration of vascular endothelial growth factor (VEGF) in patients undergoing open or laparoscopic surgery for sigmoid colon cancer. No significant differences were found between the open and laparoscopic surgery groups. *p<0.001 Preoperative (Preop) value versus the first postoperative day (POD1).

• 

  Fig. 5 Changes in the serum concentration of insulin-like growth factor binding protein-3 (IGFBP-3) in patients undergoing open or laparoscopic surgery for sigmoid colon cancer. No significant differences were found between the open and laparoscopic surgery groups. *p=0.03 Preoperative (Preop) value versus the first postoperative day (POD1). †p=0.003 Preoperative (Preop) value versus the first postoperative day (POD1).

• 

  Fig. 6 A postoperative increase of vascular endothelial growth factor (VEGF) correlates with a concentration of the first postoperative day (POD1) interleukin-6 (r=0.293, p=0.027). The ratio between the values of the POD1 versus preoperative (Preop) VEGF was used to analyze for a postoperative increase of concentration.

• 

  Fig. 7 A postoperative decrease of insulin-like growth factor binding protein-3 (IGFBP-3) correlated with a concentration of the first postoperative day (POD1) interleukin-6 (r=0.354, p=0.007). The ratio between the values of preoperative (Preop) versus the POD1 IGFBP-3 was used to analyze for a postoperative loss of the protein.

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