Comparative Study of Immune Function on Laparoscopic-Assisted and Open D2 Gastrectomy for Advanced Gastric Cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 LIUJiang-wen ¹ , SUNLin ² , TONGDe-feng ¹ , XIAJun-qiang ¹ , GONGJian-jun ¹ , DENGChang-hui ¹ , CHENXue-ling ³

1. Department of General Surgery of Shihezi People's Hospital, Shihezi 832000, Xinjiang Uygur Autonomous Region, China;
2. Department of Gastrointestinal Surgery of Dalian Municipal Central Hospital, Dalian 116033, China; Liaoning Province, China;
3. Immune Laboratory of College of Medicine, Shihezi University, Shihezi 832000, Xinjiang Uygur Autonomous Region, China;

Corresponding?author：

LIUJiang-wen, Email: ljwss@163.com

Keywords：

Advanced gastric cancer; Gastrectomy; Laparoscopy; T lymphocyte subsets; Immunoglobulin

DOI：

10.7507/1007-9424.20140295

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Objective To compare the clinical recovery and immune response between laparoscopic-assisted and open D2 gastrectomy for advanced gastric cancer. Methods The clinical data of 53 patients with advanced gastric cancer from January 2012 to October 2013 were studied prospectively. According to random number table, patients were randomly divided into laparoscopic-assisted group(LA group, n=27) and open operation group(OO group, n=26). Operative time, blood loss, time to passage of flatus, time to resume soft diet, after bed time, postoperative hospital stay, and number of retrieved lymph nodes were compared respectively between the two groups. The changes in CD3, CD4⁺, CD8⁺, IgG, IgA, IgM, and CRP were examined respectively by using flow cytometry and immunoturbidimetric assays on the preoperative day 1, and on the postoperative day 1 and 7. Results The operative time was longer significantly in LA group than that in OO group(P < 0.05). The mean blood loss, the first flatus time, after bed time, and postoperative hospital stay in the two groups were all different statistically(P < 0.05), and all were better in LA group. However, the mean number of retrieved lymph nodes and the time to resume soft diet were not significantly different in the two groups(P > 0.05). On the day 1 and 7 after operation, the CD3, CD4⁺, and CD8⁺ significantly decreased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). On the day 1 after operation, the levels of IgG, IgA, and IgM significantly decreased as compared with those preoperatively in two groups(P < 0.05). Those immunoglobulin in LA group recovered to close to the level before surgery, but in OO group sustained lower level(P < 0.05). On the day 1 and 7 after operation, CRP level significantly increased as compared with those preoperatively in two groups(P < 0.01, P < 0.05). Those changes of above index were not significantly different between the LA group and OO group on the day 1 after operation(P > 0.05). All index recovered gradually in the two groups on the day 7 after operation and were better in LA group(P < 0.05, except IgA). Conclusion Laparoscopic radical gastrectomy for advanced gastric cancer resulted in a quicker clinical recovery and a lesser depression to the perioperative cellular and humoral immune function.

Citation： LIUJiang-wen, SUNLin, TONGDe-feng, XIAJun-qiang, GONGJian-jun, DENGChang-hui, CHENXue-ling. Comparative Study of Immune Function on Laparoscopic-Assisted and Open D2 Gastrectomy for Advanced Gastric Cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2014, 21(10): 1232-1236. doi: 10.7507/1007-9424.20140295 Copy

1.	趙永亮, 余佩武, 錢鋒, 等.遠端進展期胃癌腹腔鏡輔助與開腹根治術的遠期療效比較[J].中華普通外科雜志, 2011, 26(9):713-716.
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7.	毛婧, 馬繼春, 姜雷, 等.我國腹腔鏡D2淋巴結清掃術聯合遠端胃癌切除術治療進展期遠端胃癌安全性和療效的系統評價[J].中國普外基礎與臨床雜志, 2014, 21(6):707-715.
8.	余佩武, 錢鋒, 郝迎學, 等.腹腔鏡胃癌根治術726例的療效分析[J].中華消化外科雜志, 2011, 10(1):44-47.
9.	王衛軍, 方錢, 王國平, 等.腹腔鏡胃癌根治術對患者機體細胞免疫功能的影響[J].中華實驗外科雜志, 2013, 30(1):150-152.
10.	許威, 劉宏斌, 韓曉鵬, 等.腹腔鏡胃癌根治術對高齡患者免疫功能及近期療效的影響[J].中國現代普通外科進展, 2013, 16(9):744-746.
11.	Veenhof AA, Sietses C, von Blomberg BM, et al. The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer:a randomized trial[J]. Int J Colorectal Dis, 2011, 26(1):53-59.
12.	Wang G, Jiang Z, Zhao K, et al. Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program[J]. J Gastrointest Surg, 2012, 16(7):1379-1388.

1. 趙永亮, 余佩武, 錢鋒, 等.遠端進展期胃癌腹腔鏡輔助與開腹根治術的遠期療效比較[J].中華普通外科雜志, 2011, 26(9):713-716.
2. Ohtani H, Tamamori Y, Noguchi K, et al. A meta-analysis of randomized controlled trials that compared laparoscopy-assisted and open distal gastrectomy for early gastric cancer[J]. J Gastrointest Surg, 2010, 14(6):958-964.
3. 徐大華.腹腔鏡-內鏡技術在外科的應用進展[J].中華實驗外科雜志, 2012, 29(1):10-12.
4. 中華醫學會外科分會腹腔鏡與內鏡外科學組.腹腔鏡胃癌手術操作指南(2007版)[J].中華消化外科雜志, 2007, 6(6):476-480.
5. 日本胃癌學會.胃癌治療指南修訂第3版[M].東京:金源出版株式會社, 2010:7-20.
6. 黃昌明, 林建賢, 鄭朝輝, 等.腹腔鏡輔助胃癌根治術淋巴結清掃效果的臨床對照研究[J].中華外科雜志, 2011, 49(3):200-203.
7. 毛婧, 馬繼春, 姜雷, 等.我國腹腔鏡D2淋巴結清掃術聯合遠端胃癌切除術治療進展期遠端胃癌安全性和療效的系統評價[J].中國普外基礎與臨床雜志, 2014, 21(6):707-715.
8. 余佩武, 錢鋒, 郝迎學, 等.腹腔鏡胃癌根治術726例的療效分析[J].中華消化外科雜志, 2011, 10(1):44-47.
9. 王衛軍, 方錢, 王國平, 等.腹腔鏡胃癌根治術對患者機體細胞免疫功能的影響[J].中華實驗外科雜志, 2013, 30(1):150-152.
10. 許威, 劉宏斌, 韓曉鵬, 等.腹腔鏡胃癌根治術對高齡患者免疫功能及近期療效的影響[J].中國現代普通外科進展, 2013, 16(9):744-746.
11. Veenhof AA, Sietses C, von Blomberg BM, et al. The surgical stress response and postoperative immune function after laparoscopic or conventional total mesorectal excision in rectal cancer:a randomized trial[J]. Int J Colorectal Dis, 2011, 26(1):53-59.
12. Wang G, Jiang Z, Zhao K, et al. Immunologic response after laparoscopic colon cancer operation within an enhanced recovery program[J]. J Gastrointest Surg, 2012, 16(7):1379-1388.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative Study of Immune Function on Laparoscopic-Assisted and Open D2 Gastrectomy for Advanced Gastric Cancer

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