Cellular and peritoneal immune response after radical laparoscopy-assisted and open gastrectomy for gastric cancer

Background and objectives: The aim of this study was to assess cellular and peritoneal immune responses after radical laparoscopic surgery in gastric cancer. Methods: Peripheral heparinized plasma and plain serum tube samples were collected preoperatively, and at 2 hr, I day, and 4 days postoperatively for analysis o; white blood cells, total lymphocytes, T-helper lymphocytes, T-suppressor lymphocytes, B-lymphocytes, natural killer cells, plasma C-reactive protein and serum amyloid-A. Twenty-four hours peritoneal fluid collection was performed on days I and 4 for TNF-alpha, IL-6, and IL-10 analysis. Results: No statistical differences were observed between the two groups with respect to immunocompetent cell counts. The serum levels of plasma CRP and SAA gradually increased significantly with time in both groups, but these temporal increases were lower in the LADG group (CRP; P = 0.03, SAA; P 0.01). Peritoneal TNF-alpha levels in the CODG group at 4 days postoperatively were significantly higher than at day 1, but remained almost unchanged in the LADG group, and this difference was significant (P = 0.02). Conclusion: Because of its association with reduced peritoneal immune activity, laparoscopic surgery for advanced gastric cancer may require careful consideration in practice. Additional, larger prospective multicenter trials are required before a consensus can be reached.