54953
document
Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program . OBJECTIVE It has been demonstrated that colon operation combined with fast-track ( FT ) surgery and laparoscopic technique can shorten the length of hospital stay , accelerate recovery of intestinal function , and reduce the occurrence of post-operative complications . However , there are no reports regarding the combined effects of FT colon operation and laparoscopic technique on humoral inflammatory cellular immunity . METHODS This was a prospective , controlled study . One hundred sixty-three colon cancer patients underwent the traditional protocol and open operation ( traditional open group , n=42 ) , the traditional protocol and laparoscopic operation ( traditional laparoscopic group , n=40 ) , the FT protocol and open operation ( FT open group , n=41 ) , or the FT protocol and laparoscopic operation ( FT laparoscopic group , n=40 ) . Blood samples were taken prior to operation as well as on days 1 , 3 , and 5 after operation . The number of lymphocyte subpopulations was determined by flow cytometry , and serum interleukin-6 and C-reactive protein levels were measured . Post-operative hospital stay , post-operative morbidity , readmission rate , and in-hospital mortality were recorded . RESULTS Compared with open operation , laparoscopic colon operation effectively inhibited the release of post-operative inflammatory factors and yielded good protection via post-operative cell immunity . FT surgery had a better protective role with respect to the post-operative immune system compared with traditional peri-operative care . Inflammatory reactions , based on interleukin-6 and C-reactive protein levels , were less intense following FT laparoscopic operation compared to FT open operation ; however , there were no differences in specific immunity ( CD3+ and CD4+ counts , and the CD4+/CD8+ ratio ) during these two types of surgical procedures . Post-operative hospital stay in patients randomized to the FT laparoscopic group was significantly shorter than in the other three treatment groups ( P < 0.01 ) . Post-operative complications in patients who underwent FT laparoscopic treatment were less than in the other three treatment groups ( P < 0.05 ) . There were no significant differences between the four treatment groups regarding readmission rate and in-hospital mortality . CONCLUSIONS The laparoscopic technique and FT surgery rehabilitation program effectively inhibited release of post-operative inflammatory factors with a reduction in peri-operative trauma and stress , which together played a protective role on the post-operative immune system . Combining two treatment measures during colon operation produced better protective effects via the immune system . The beneficial clinical effects support that the better-preserved post-operative immune system may also contribute to the improvement of post-operative results in FT laparoscopic patients .
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Intervention_Surgical
traditional protocol
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Intervention_Surgical
open operation
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Intervention_Surgical
traditional protocol
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Intervention_Surgical
laparoscopic operation
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Intervention_Surgical
FT protocol
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Intervention_Surgical
open operation
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Intervention_Surgical
FT protocol
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Intervention_Surgical
laparoscopic operation
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Outcome_Physical
Immunologic response
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Outcome_Other
length of hospital stay
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Outcome_Physical
accelerate recovery of intestinal function
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Outcome_Adverse-effects
reduce the occurrence of post-operative complications
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Outcome_Physical
humoral inflammatory cellular immunity .
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Outcome_Physical
number of lymphocyte subpopulations
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Outcome_Physical
serum interleukin-6 and C-reactive protein levels
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Outcome_Other
Post-operative hospital stay
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Outcome_Adverse-effects
post-operative morbidity
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Outcome_Other
readmission rate ,
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Outcome_Mortality
in-hospital mortality
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Outcome_Physical
post-operative inflammatory factors
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Outcome_Physical
Inflammatory reactions , based on interleukin-6 and C-reactive protein levels
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Outcome_Physical
specific immunity ( CD3+ and CD4+ counts , and the CD4+/CD8+ ratio )
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Outcome_Other
Post-operative hospital stay
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Outcome_Adverse-effects
Post-operative complications
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Outcome_Other
readmission rate
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Outcome_Mortality
in-hospital mortality
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Outcome_Physical
post-operative inflammatory factors with a reduction in peri-operative trauma and stress
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Outcome_Other
protective effects via the immune system
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Outcome_Physical
.
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Outcome_Physical
improvement of post-operative results
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Participant_Condition
laparoscopic colon cancer operation
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Participant_Sample-size
One hundred sixty-three
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Participant_Condition
colon cancer
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Participant_Condition
laparoscopic operation