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document
Immunological changes after minimally invasive or conventional esophageal resection for cancer : a randomized trial . BACKGROUND This study was performed as a substudy analysis of a randomized trial comparing conventional open esophagectomy [ open surgical technique ( OE ) ] by thoracotomy and laparotomy with minimally invasive esophagectomy [ minimally invasive procedure ( MIE ) ] by thoracoscopy and laparoscopy . This additional analysis focuses on the immunological changes and surgical stress response in these two randomized groups of a single center . METHODS Patients with a resectable esophageal cancer were randomized to OE ( n = 13 ) or MIE ( n = 14 ) . All patients received neoadjuvant chemoradiotherapy . The immunological response was measured by means of leukocyte counts , HLA-DR expression on monocytes , the acute-phase response by means of C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , and interleukin-8 ( IL-8 ) , and the stress response was measured by cortisol , growth hormone , and prolactin . All parameters were determined at baseline ( preoperatively ) and 24 , 72 , 96 , and 168 h postoperatively . RESULTS Significant differences between the two groups were seen in favor of the MIE group with regard to leukocyte counts , IL-8 , and prolactin at 168 h ( 1 week ) postoperatively . For HLA-DR expression , IL-6 , and CRP levels , there were no significant differences between the two groups , although there was a clear rise in levels upon operation in both groups . CONCLUSION In this substudy of a randomized trial comparing minimally invasive and conventional open esophagectomies for cancer , significantly better preserved leukocyte counts and IL-8 levels were observed in the MIE group compared to the open group . Both findings can be related to fewer respiratory infections found postoperatively in the MIE group . Moreover , significant differences in the prolactin levels at 168 h after surgery imply that the stress response is better preserved in the MIE group . These findings indicate that less surgical trauma could lead to better preserved acute-phase and stress responses and fewer clinical manifestations of respiratory infections .
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Intervention_Surgical
minimally invasive
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Intervention_Physical
or
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Intervention_Surgical
conventional esophageal resection
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Intervention_Surgical
conventional open esophagectomy
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Intervention_Surgical
thoracotomy and laparotomy
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Intervention_Surgical
minimally invasive procedure ( MIE )
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Intervention_Surgical
thoracoscopy
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Intervention_Surgical
laparoscopy
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Intervention_Pharmacological
neoadjuvant chemoradiotherapy
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Intervention_Surgical
MIE
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Outcome_Physical
Immunological changes
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Outcome_Physical
immunological changes
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Outcome_Physical
surgical stress response
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Outcome_Physical
immunological response
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Outcome_Physical
leukocyte counts , HLA-DR expression on monocytes , the acute-phase response by means of C-reactive protein ( CRP ) , interleukin-6 ( IL-6 ) , and interleukin-8 ( IL-8 ) , and the stress response was measured by cortisol , growth hormone , and prolactin .
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Outcome_Physical
leukocyte counts , IL-8 , and prolactin
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Outcome_Physical
HLA-DR expression , IL-6 , and CRP levels
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Outcome_Physical
leukocyte counts and IL-8 levels
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Outcome_Physical
fewer respiratory infections
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Outcome_Physical
prolactin levels
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Outcome_Physical
stress response
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Participant_Condition
cancer
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Participant_Condition
resectable esophageal cancer
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Participant_Sample-size
13
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Participant_Sample-size
14