Comparison of Laparoscopic Versus Open Radical Surgery for Colorectal Cancer in Stress Response: A Meta-Analysis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 MAOZi-han ,  ZHANGHong , CONGJin-chun , LINGYun-zhi , LIUDing-sheng , CUIMing-ming , CHENChun-sheng

Department of Colorectal Tumor Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China;

Corresponding?author：

ZHANGHong, Email: haojiubujian1203@sina.cn

Keywords：

Laparoscopy; Open surgery; Colorectal cancer; Stress

DOI：

10.7507/1007-9424.20160276

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Objective To systematically evaluate the stress response of laparoscopic surgery (LS) and conventional open surgery (OS) in patients with colorectal cancer. Methods The literatures about the immune stress response of LS and OS for colorectal cancer were collected from PubMed, Springer, OVID, Cochrane library, CNKI, VIP Database, and Wanfang Database from May 2001 to September 2014. RevMan 5.3 software was used for data analysis. Results Fifteen randomized controlled trials including 881 patients were brought into this Meta analysis, of 881 patients, 424 patients were treated with LS and 457 patients were treated with OS. The results of Meta-analysis showed that:①At 24, 72, and 120 hours after surgery, the levels of interleukin (IL-6) in LS group were all lower than those of OS group at same time point[24 h (WMD=-27.78, 95% CI:-43.24--12.32, P < 0.01), 72 h (WMD=-13.23, 95% CI:-19.89--6.57, P < 0.01), 120 h (WMD=-16.51, 95% CI:-30.13--2.89, P=0.02)]. ②At 24, 72, and 120 hours after surgery, the levels of C reactive protein (CRP) in LS group were all lower than those of OS group at same time point[24 h (WMD=-31.11, 95% CI:-47.49--14.73, P < 0.01), 72 h (WMD=-29.81, 95% CI:-49.99--9.64, P < 0.01), 120 h (WMD=-32.03, 95% CI:-45.34--18.71, P < 0.01)]. ③There was no significant difference between the 2 groups in WBC level at 24 hours after surgery (WMD=-0.63, 95% CI:-1.80-0.54, P=0.29), but the WBC levels of LS group at 72 hours and 120 hours after surgery were lower than those of OS group[72 h (WMD=-0.21, 95% CI:-0.41--0.01, P=0.04), 120 h (WMD=-0.86, 95% CI:-1.66--0.06, P=0.03). ④There was no significant difference between the 2 groups in cortisol level at 24 hours and 72 hours after surgery[24 h (WMD=-60.19, 95% CI:-194.77-74.39, P=0.38), 72 h (WMD=-13.83, 95% CI:-43.94-16.28, P=0.37). ⑤There was no significant difference between the 2 groups in blood glucose level at 24 hours and 72 hours after surgery[24 h (WMD=-0.95, 95% CI:-2.74-0.84, P=0.30), 72 h (WMD=-0.69, 95% CI:-2.05-0.66, P=0.32)]. ⑥There was no significant difference between the 2 groups in insulin level (WMD=-0.52, 95% CI:-1.87-0.82, P=0.45) at 24 hours after surgery. ⑦There was no significant difference between the 2 groups in tumor necrosis factor (TNF) level at 24 hours after surgery (WMD=-4.18, 95% CI:-9.39-1.04, P=0.12). Conclusion Compared with open radical surgery, laparoscopic radical surgery for colorectal cancer causes less stress and less effect on the immune function, it also can reduce postoperative complications and can be propitious to faster body recovery.

Citation： MAO Zi-han, ZHANG Hong, CONG Jin-chun, LING Yun-zhi, LIU Ding-sheng, CUI Ming-ming, CHEN Chun-sheng. Comparison of Laparoscopic Versus Open Radical Surgery for Colorectal Cancer in Stress Response: A Meta-Analysis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2016, 23(9): 1073-1083. doi: 10.7507/1007-9424.20160276 Copy

1.	Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3):144-150.
2.	Luo K, Li JS, Li LT, et al. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol, 2003, 9(4):847-850.
3.	Haque Z, Rahman M, Siddique MA, et al. Metabolic and stress responses of the body to trauma:produced by the laparoscopic and open cholecystectomy. Mymensingh Med J, 2004, 13(1):48-52.
4.	Nakamura T, Mitomi H, Ohtani Y, et al. Comparison of long-term outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer. Hepatogastroenterology, 2006, 53(69):351-353.
5.	張淼, 張云, 魚海峰, 等.腹腔鏡與傳統開腹結直腸癌根治手術療效比較.中國現代普通外科進展, 2012, 15(5):410-411.
6.	Braga M, Frasson M, Vignali A, et al. Laparoscopic resection in rectal cancer patients:outcome and cost-benefit analysis. Dis Colon Rectum, 2007, 50(4):464-471.
7.	王玉林, 陳元, 汪翼, 等. 《中華兒科雜志》發表的治療性研究文獻質量評價.中華兒科雜志, 2013, 51(1):29-33.
8.	葉乾禮, 林建榮, 林世強.腹腔鏡輔助結直腸癌根治術對機體應激反應的影響分析.中國醫學工程, 2014, 22(9):68-69.
9.	周保軍, 張國建, 段國強, 等.腹腔鏡和開腹直腸癌保肛手術對機體應激反應的影響.世界華人消化雜志, 2007, 15(26):2856-2859.
10.	趙波, 吳衛, 徐艷松, 等.腹腔鏡結直腸癌與開腹手術對應激相關因子的對比研究.結直腸肛門外科, 2013, 19(2):73-76.
11.	李炳輝, 張彩坤, 齊湘杰.腹腔鏡手術對腹型肥胖直腸癌患者術后代謝影響的研究.中國臨床實用醫學, 2008, 2(6):29-30.
12.	陳一偉, 吳慶華, 夏兆立.腹腔鏡與開腹結直腸癌根治術對機體應激反應的影響.臨床合理用藥雜志, 2013, 6(25):131.
13.	潘書鴻, 張從雨, 潘緒科, 等.腹腔鏡與開腹結直腸癌手術對機體應激反應及細胞免疫功能影響的比較.中國現代普通外科進展, 2014, 17(5):408-411.
14.	陳欣, 呂振曄.腹腔鏡與開腹直腸癌根治術對機體應激及內臟蛋白的影響.河北醫科大學學報, 2012, 33(4):399-401.
15.	曹傳培, 汪峰.腹腔鏡與開腹直腸癌根治術對老年患者機體應激的影響.中國當代醫藥, 2014, 21(26):171-173.
16.	江秀麗, 王倩, 張建立, 等.腹腔鏡與開腹直腸癌術后應激反應期ghrelin的動態變化及意義.醫學研究生學報, 2013, 26(8):823-828.
17.	Wu FP, Hoekman K, Sietses C, et al, Systemic and peritoneal angiogenic response after laparoscopic or conventional colon resection in cancer patients:a prospective, randomized trial. Dis Colon Rectum, 2004, 47(10):1670-1674.
18.	Veenhof AA, Vlug MS, van der Pas MH, et al. Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial. Ann Surg, 2012, 255(2):216-221.
19.	Delgado S, Lacy AM, Filella X, et al. Acute phase response in laparoscopic and open colectomy in colon cancer. Dis Colon Rectum, 2001, 44(5):638-646.
20.	Kvarnstr?m A, Swartling T, Kurlberg G, et al. Pro-inflammatory cytokine release in rectal surgery:comparison between laparoscopic and open surgical techniques. Arch Immunol Ther Exp (Warsz), 2013, 61(5):407-411.
21.	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. Int J Colorectal Dis, 2011, 26(1):53-59.
22.	Tsimogiannis KE, Tellis CC, Tselepis AD, et al. Toll-like receptors in the inflammatory response during open and laparoscopic colectomy for colorectal cancer. Surg Endosc, 2012, 26(2):330-336.
23.	Haga Y, Beppu T, DoiK, et al. Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery. Crit Care Med, 1997, 25(12):1994-2000.
24.	Cunliffe RN, Kamal M, Rose FR, et al. Expression of antimicrobial neutrophil defensins in epithelial cells of active inflammatory bowel disease mucosa. J Clin Pathol, 2002, 55(4):298-304.
25.	Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury, 2007, 38(12):1336-1345.
26.	Kehlet H. The surgical stress response:should it be prevented?. Can J Surg, 1991, 34(6):565-567.
27.	Tang CL, Eu KW, Tai BC, et al. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg, 2001, 88(6):801-807.
28.	Wigmore SJ, MacMahon AJ, Sturgeon CM, et al. Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer. Br J Surg, 2001, 37(88):255-260.
29.	楊碩, 張建立.腹腔鏡與開腹結直腸癌根治術對機體免疫系統影響的比較研究.腹腔鏡外科雜志, 2008, 13(1):22-24.
30.	Allendorf JD, Bessler M, Horvath KD, et al. Increased tumor establishment and growth after open vs laparoscopic surgery in mice may be related to differences in postoperative T-cell function. Surg Endosc, 1999, 13(3):233-235.
31.	Lennard TW, Shenton BK, Borzotta A, et al. The influence of surgical operations on components of the human immune system. Br J Surg, 1985, 72(10):771-776.
32.	趙剛, 肖剛, 黃美雄, 等.腹腔鏡結直腸癌根治對機體免疫狀態的影響.中華胃腸外科雜志, 2005, 8(5):407-409.
33.	Wakefield CH, Carey PD, Foulds S, et al. Changes in major histocompatibility complex class Ⅱ expression in monocytes and T cells of patients developing infection after surgery. Br J Surg, 1993, 80(2):205-209.
34.	葉平江, 郭貴龍, 應曉江, 等.腹腔鏡與開腹結直腸癌根治術對機體免疫系統影響的比較研究.中國內鏡雜志, 2011, 17(5):478-480.
35.	周志濤, 李俊, 毛常青, 等.腹腔鏡直腸癌根治術對患者免疫功能影響的研究.實用預防醫學, 2011, 18(5):895-897.
36.	Jakeways MS, Mitchell V, Hashim IA, et al. Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg, 1994, 81(1):127-131.
37.	Ordemann J, Jacobi CA, Schwenk W, et al. Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections. Surg Endosc, 2001, 15(6):600-608.
38.	Whelan RL, Franklin M, Holubar SD, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc, 2003, 17(6):972-978.
39.	Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med, 1999, 340(6):448-454.
40.	Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation:a systematic review. Surgery, 2015, 157(2):362-380.
41.	田玉科, 羅愛林, 金士翱.重度創傷后血清腫瘤壞死因子α及白細胞介素6水平變化與感染性并發癥的關系.中華實驗外科雜志, 1999, 16(1):38-39.
42.	Ogawa K, Hirai M, Katsube T, et al. Suppression of cellular immunity by surgical stress. Surgery, 2000, 127(3):329-336.
43.	Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma:prospective randomised trial. Lancet, 2004, 363(9416):1187-1192.
44.	Nash GF. Randomized clinical trial comparing inflammatory and angiogenic response after open versus laparoscopic curative resection for colonic cancer. Br J Surg, 2011, 98(5):745-746.
45.	Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J, 1990, 265(3):282-291.
46.	Tsamis D, Theodoropoulos G, Stamopoulos P, et al. Systemic inflammatory response after laparoscopic and conventional colectomy for cancer:a matched case-control study. Surg Endosc, 2012, 26(5):1436-1443.
47.	Wichmann MW, Hüttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery:a prospective clinical study. Arch Surg, 2005, 140(7):692-697.
48.	Sammour T, Kahokehr A, Chan S, et al. The humoral response after laparoscopic versus open colorectal surgery:a meta-analysis. J Surg Res, 2010, 164(1):28-37.
49.	李豫江, 李志剛, 孫旭凌, 等.腹腔鏡與開腹直腸癌根治術對機體C反應蛋白及細胞免疫影響的比較.臨床和實驗醫學雜志, 2012, 11(13):1031-1033.
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1. Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg Laparosc Endosc, 1991, 1(3):144-150.
2. Luo K, Li JS, Li LT, et al. Operative stress response and energy metabolism after laparoscopic cholecystectomy compared to open surgery. World J Gastroenterol, 2003, 9(4):847-850.
3. Haque Z, Rahman M, Siddique MA, et al. Metabolic and stress responses of the body to trauma:produced by the laparoscopic and open cholecystectomy. Mymensingh Med J, 2004, 13(1):48-52.
4. Nakamura T, Mitomi H, Ohtani Y, et al. Comparison of long-term outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer. Hepatogastroenterology, 2006, 53(69):351-353.
5. 張淼, 張云, 魚海峰, 等.腹腔鏡與傳統開腹結直腸癌根治手術療效比較.中國現代普通外科進展, 2012, 15(5):410-411.
6. Braga M, Frasson M, Vignali A, et al. Laparoscopic resection in rectal cancer patients:outcome and cost-benefit analysis. Dis Colon Rectum, 2007, 50(4):464-471.
7. 王玉林, 陳元, 汪翼, 等. 《中華兒科雜志》發表的治療性研究文獻質量評價.中華兒科雜志, 2013, 51(1):29-33.
8. 葉乾禮, 林建榮, 林世強.腹腔鏡輔助結直腸癌根治術對機體應激反應的影響分析.中國醫學工程, 2014, 22(9):68-69.
9. 周保軍, 張國建, 段國強, 等.腹腔鏡和開腹直腸癌保肛手術對機體應激反應的影響.世界華人消化雜志, 2007, 15(26):2856-2859.
10. 趙波, 吳衛, 徐艷松, 等.腹腔鏡結直腸癌與開腹手術對應激相關因子的對比研究.結直腸肛門外科, 2013, 19(2):73-76.
11. 李炳輝, 張彩坤, 齊湘杰.腹腔鏡手術對腹型肥胖直腸癌患者術后代謝影響的研究.中國臨床實用醫學, 2008, 2(6):29-30.
12. 陳一偉, 吳慶華, 夏兆立.腹腔鏡與開腹結直腸癌根治術對機體應激反應的影響.臨床合理用藥雜志, 2013, 6(25):131.
13. 潘書鴻, 張從雨, 潘緒科, 等.腹腔鏡與開腹結直腸癌手術對機體應激反應及細胞免疫功能影響的比較.中國現代普通外科進展, 2014, 17(5):408-411.
14. 陳欣, 呂振曄.腹腔鏡與開腹直腸癌根治術對機體應激及內臟蛋白的影響.河北醫科大學學報, 2012, 33(4):399-401.
15. 曹傳培, 汪峰.腹腔鏡與開腹直腸癌根治術對老年患者機體應激的影響.中國當代醫藥, 2014, 21(26):171-173.
16. 江秀麗, 王倩, 張建立, 等.腹腔鏡與開腹直腸癌術后應激反應期ghrelin的動態變化及意義.醫學研究生學報, 2013, 26(8):823-828.
17. Wu FP, Hoekman K, Sietses C, et al, Systemic and peritoneal angiogenic response after laparoscopic or conventional colon resection in cancer patients:a prospective, randomized trial. Dis Colon Rectum, 2004, 47(10):1670-1674.
18. Veenhof AA, Vlug MS, van der Pas MH, et al. Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care:a randomized trial. Ann Surg, 2012, 255(2):216-221.
19. Delgado S, Lacy AM, Filella X, et al. Acute phase response in laparoscopic and open colectomy in colon cancer. Dis Colon Rectum, 2001, 44(5):638-646.
20. Kvarnstr?m A, Swartling T, Kurlberg G, et al. Pro-inflammatory cytokine release in rectal surgery:comparison between laparoscopic and open surgical techniques. Arch Immunol Ther Exp (Warsz), 2013, 61(5):407-411.
21. 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. Int J Colorectal Dis, 2011, 26(1):53-59.
22. Tsimogiannis KE, Tellis CC, Tselepis AD, et al. Toll-like receptors in the inflammatory response during open and laparoscopic colectomy for colorectal cancer. Surg Endosc, 2012, 26(2):330-336.
23. Haga Y, Beppu T, DoiK, et al. Systemic inflammatory response syndrome and organ dysfunction following gastrointestinal surgery. Crit Care Med, 1997, 25(12):1994-2000.
24. Cunliffe RN, Kamal M, Rose FR, et al. Expression of antimicrobial neutrophil defensins in epithelial cells of active inflammatory bowel disease mucosa. J Clin Pathol, 2002, 55(4):298-304.
25. Lenz A, Franklin GA, Cheadle WG. Systemic inflammation after trauma. Injury, 2007, 38(12):1336-1345.
26. Kehlet H. The surgical stress response:should it be prevented?. Can J Surg, 1991, 34(6):565-567.
27. Tang CL, Eu KW, Tai BC, et al. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg, 2001, 88(6):801-807.
28. Wigmore SJ, MacMahon AJ, Sturgeon CM, et al. Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer. Br J Surg, 2001, 37(88):255-260.
29. 楊碩, 張建立.腹腔鏡與開腹結直腸癌根治術對機體免疫系統影響的比較研究.腹腔鏡外科雜志, 2008, 13(1):22-24.
30. Allendorf JD, Bessler M, Horvath KD, et al. Increased tumor establishment and growth after open vs laparoscopic surgery in mice may be related to differences in postoperative T-cell function. Surg Endosc, 1999, 13(3):233-235.
31. Lennard TW, Shenton BK, Borzotta A, et al. The influence of surgical operations on components of the human immune system. Br J Surg, 1985, 72(10):771-776.
32. 趙剛, 肖剛, 黃美雄, 等.腹腔鏡結直腸癌根治對機體免疫狀態的影響.中華胃腸外科雜志, 2005, 8(5):407-409.
33. Wakefield CH, Carey PD, Foulds S, et al. Changes in major histocompatibility complex class Ⅱ expression in monocytes and T cells of patients developing infection after surgery. Br J Surg, 1993, 80(2):205-209.
34. 葉平江, 郭貴龍, 應曉江, 等.腹腔鏡與開腹結直腸癌根治術對機體免疫系統影響的比較研究.中國內鏡雜志, 2011, 17(5):478-480.
35. 周志濤, 李俊, 毛常青, 等.腹腔鏡直腸癌根治術對患者免疫功能影響的研究.實用預防醫學, 2011, 18(5):895-897.
36. Jakeways MS, Mitchell V, Hashim IA, et al. Metabolic and inflammatory responses after open or laparoscopic cholecystectomy. Br J Surg, 1994, 81(1):127-131.
37. Ordemann J, Jacobi CA, Schwenk W, et al. Cellular and humoral inflammatory response after laparoscopic and conventional colorectal resections. Surg Endosc, 2001, 15(6):600-608.
38. Whelan RL, Franklin M, Holubar SD, et al. Postoperative cell mediated immune response is better preserved after laparoscopic vs open colorectal resection in humans. Surg Endosc, 2003, 17(6):972-978.
39. Gabay C, Kushner I. Acute-phase proteins and other systemic responses to inflammation. N Engl J Med, 1999, 340(6):448-454.
40. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation:a systematic review. Surgery, 2015, 157(2):362-380.
41. 田玉科, 羅愛林, 金士翱.重度創傷后血清腫瘤壞死因子α及白細胞介素6水平變化與感染性并發癥的關系.中華實驗外科雜志, 1999, 16(1):38-39.
42. Ogawa K, Hirai M, Katsube T, et al. Suppression of cellular immunity by surgical stress. Surgery, 2000, 127(3):329-336.
43. Leung KL, Kwok SP, Lam SC, et al. Laparoscopic resection of rectosigmoid carcinoma:prospective randomised trial. Lancet, 2004, 363(9416):1187-1192.
44. Nash GF. Randomized clinical trial comparing inflammatory and angiogenic response after open versus laparoscopic curative resection for colonic cancer. Br J Surg, 2011, 98(5):745-746.
45. Heinrich PC, Castell JV, Andus T. Interleukin-6 and the acute phase response. Biochem J, 1990, 265(3):282-291.
46. Tsamis D, Theodoropoulos G, Stamopoulos P, et al. Systemic inflammatory response after laparoscopic and conventional colectomy for cancer:a matched case-control study. Surg Endosc, 2012, 26(5):1436-1443.
47. Wichmann MW, Hüttl TP, Winter H, et al. Immunological effects of laparoscopic vs open colorectal surgery:a prospective clinical study. Arch Surg, 2005, 140(7):692-697.
48. Sammour T, Kahokehr A, Chan S, et al. The humoral response after laparoscopic versus open colorectal surgery:a meta-analysis. J Surg Res, 2010, 164(1):28-37.
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CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of Laparoscopic Versus Open Radical Surgery for Colorectal Cancer in Stress Response: A Meta-Analysis

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