Cytokine Response to Surgical Stress: Comparison of Pure Laparoscopic, Hand-Assisted Laparoscopic, and Open Nephrectomy

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Abstract
Background and Purpose: Laparoscopic surgery has been shown to induce less immune suppression than open surgery, presumably because there is less tissue trauma, a factor that may impact oncologic-disease control. The objective of this study was to compare the cytokine and stress response associated with pure laparoscopic, hand-assisted laparoscopic (HAL), and open nephrectomy. Material and Methods: Fifteen female farm pigs (45–50 kg) underwent transperitoneal laparoscopic, handassisted (HAL), or open nephrectomy (N = 5 in each group). At 1, 4, 24, and 48 hours post-nephrectomy, blood and peritoneal fluid samples were collected for measurement of tumor necrosis factor (TNF) α, interleukin (IL)-1β, and IL-6 using enzyme-linked immunosorbent assay (ELISA) techniques. Body temperature and serum glucose and cortisol were also measured. Results: No evidence of perioperative infection was detected in any animal through temperature and glucose monitoring. Operating time and blood loss were comparable among the three groups. Peak serum cortisol concentrations were significantly higher in the HAL group than in the pure laparoscopic group at 24 hours (P = 0.02). Serum TFNα concentrations were significantly lower in the pure laparoscopy group (40 ± 6 pg/mL) than in the HAL and open-nephrectomy groups (81 ± 6 pg/mL and 83 ± 17 pg/mL, respectively; P < 0.05), although no differences between groups were found in the serum IL-1β and IL-6 concentrations. Peritoneal IL-1β was significantly higher in the HAL than in the open-nephrectomy group (2993 ± 507 pg/mL and 733 ± 185 pg/mL, respectively; P = 0.05). Peritoneal IL-6 was significantly lower in the pure laparoscopy group (694 ± 234 pg/mL) than in the open-surgery group (1668 ± 312 pg/mL) (P = 0.04). Conclusion: Pure laparoscopic surgery in pigs elicits a less-robust cytokine response than HAL or open nephrectomy with respect to serum TNFα and peritoneal IL-6 concentrations, perhaps reflecting less impairment of the immune system. Clinical confirmation is required, and the implications with regard to oncologic tumor surveillance in humans require further study.