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Revista Mexicana de Coloproctología Enfermedades del Ano, Recto y Colon

2009, Number 3

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Rev Mex Coloproctol 2009; 15 (3)

Immunologic analysis of results of the use of minimal invasive surgery in colon cancer

Reis NJA, Reis JJA

Language: Spanish
References: 68
Page: 56-64
PDF size: 249.64 Kb.


ABSTRACT

Objective: It’s laparoscopy better than laparotomy or open surgery?, in colon cancer and it’s relation to the immunology answer. Authors will demonstrate with the analysis of the studies reviewed by them. Material and methods: Prospective randomized studies were made by several authors; Wu et al. analyze the immunology function after colectomies realized by laparotomy and by laparoscopy, in some of them they analyzed the serum studies in the blood and peritoneal cytokines as interleukins IL6 of PCR (polymerase chain action) of histocompatibility HLD-DR and the TNF. Another authors; Hildebert et al. Furthermore of this they study the elastolysis. Other authors analyzed the levels of the protein surface CD31. This has the important function in the expression of the suppressors T cell. This protein is involved in the transendothelial transposition that is consider as an indicator of the activation of suppressor T-cell, making this analysis in preoperative and postoperative of the CD 31 protein and in the 1st and 3rd day of postoperative in each patients group. A work of Oderman et al, of 40 patients with colorectal cancer underwent or submmited to surgery treatment, dividing two groups, one by laparotomy and other by laparoscopy, evaluating different immunologic parameters (WBC, CD4, CD8, HLA, DR, IL6 and making cytokine PBMC). But more interesting was the evaluation of the CD31 Protein level according along (extension or length) of the incision. As longer the incision, is bigger the low CD31 protein level in the circulation, Other similar study made with CD25 protein that has the similar function with the CD31 protein in the T-suppressor cells expression, have registered important low of the level of the same significant statistically in the first day of the postoperative of the operated patients by laparotomy. In the operated patients by laparoscopy there wasn’t alteration of the CD25 protein levels in the postoperative. Finally in a study with protein relationeds with tumoral MMP-3 and TIMP-1 growth, comparing the results obtainers in the pre and postoperative (days 1 to 4), have demonstrated an increase the level of them in the patients operated by laparotomy and the vascular endothelial growth level factor evaluation (VEGF) important promoter or advancer of the angiogenesis, helping the health bund and concomitance in the tumoral growth. Results: Results have demonstrate A) Significant variation of IL-6 interleukin in the 4th day of postoperative in patients opered by laparotomy comparing to verified in patients treated with laparoscopy. B) HLA-DR (histocompatibility) expression is significantly minor in patients opered by conventional way in the same postoperative period. C) Significant difference of the interleukins IL-6 and IL-8 levels, in the next postoperative (two hours after the opered), but it was observe that this variation was minor in opered patients with laparoscopy. D) The numbers of leukocytes and monocytes as the HLA-DR, (histocompatibility) expression. They that normalize quickly after the surgery by laparoscopy. E) The describe differences happen in a short time period, also A minor immunologic postoperative repercussion in the colectomy made by laparoscopy also at the colectomias laparotomy there was. Not relationed with statistics worth. Finally high VEGF Level in preoperative are relationed with the cancer stadium and the patient prognostic, this difference observed in the elevation or height of VEGF Levels between the two groups was statistically excellent. Conclusion: All this studies published, relationating the values and the immunologic alterations in patients opereds by laparoscopy is significantly low the immunosuppressant to the increase of all the 4 basic parameters observed, the biggest differences between the two surgical methods were found in the interleukins IL-6 an eleasthosys levels, thus all this were of short length. The laparotomy (conventional) is the one that cause more alterations in the plasma composition in the postoperative, another interesting observation was made with inhibitors proteins of tumoral growth, IGFBP-3 (tumoral inhibitor that promote the apotheosis) in particular, comparing the levels gained in the pre and postoperative in colon rectal cancer. The patients revelated that laparotomy surgery produced a low of IGFBP-3 in the postoperative statistically significant in the relation to the MMP-9 protein (relationed to the tumoral growth) has observed a increase level of it immediately after the laparotomy surgery, level, that is normal again in 48 hours after the surgery, this variation is statistically significant. Finally the conventional surgery has significant elevations in the postoperative level of VEGF.


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