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

Video：

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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.	赵永亮, 余佩武, 钱锋, 等.远端进展期胃癌腹腔镜辅助与开腹根治术的远期疗效比较[J].中华普通外科杂志, 2011, 26(9):713-716.
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7.	毛婧, 马继春, 姜雷, 等.我国腹腔镜D2淋巴结清扫术联合远端胃癌切除术治疗进展期远端胃癌安全性和疗效的系统评价[J].中国普外基础与临床杂志, 2014, 21(6):707-715.
8.	余佩武, 钱锋, 郝迎学, 等.腹腔镜胃癌根治术726例的疗效分析[J].中华消化外科杂志, 2011, 10(1):44-47.
9.	王卫军, 方钱, 王国平, 等.腹腔镜胃癌根治术对患者机体细胞免疫功能的影响[J].中华实验外科杂志, 2013, 30(1):150-152.
10.	许威, 刘宏斌, 韩晓鹏, 等.腹腔镜胃癌根治术对高龄患者免疫功能及近期疗效的影响[J].中国现代普通外科进展, 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. 赵永亮, 余佩武, 钱锋, 等.远端进展期胃癌腹腔镜辅助与开腹根治术的远期疗效比较[J].中华普通外科杂志, 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. 徐大华.腹腔镜-内镜技术在外科的应用进展[J].中华实验外科杂志, 2012, 29(1):10-12.
4. 中华医学会外科分会腹腔镜与内镜外科学组.腹腔镜胃癌手术操作指南(2007版)[J].中华消化外科杂志, 2007, 6(6):476-480.
5. 日本胃癌学会.胃癌治疗指南修订第3版[M].东京:金源出版株式会社, 2010:7-20.
6. 黄昌明, 林建贤, 郑朝辉, 等.腹腔镜辅助胃癌根治术淋巴结清扫效果的临床对照研究[J].中华外科杂志, 2011, 49(3):200-203.
7. 毛婧, 马继春, 姜雷, 等.我国腹腔镜D2淋巴结清扫术联合远端胃癌切除术治疗进展期远端胃癌安全性和疗效的系统评价[J].中国普外基础与临床杂志, 2014, 21(6):707-715.
8. 余佩武, 钱锋, 郝迎学, 等.腹腔镜胃癌根治术726例的疗效分析[J].中华消化外科杂志, 2011, 10(1):44-47.
9. 王卫军, 方钱, 王国平, 等.腹腔镜胃癌根治术对患者机体细胞免疫功能的影响[J].中华实验外科杂志, 2013, 30(1):150-152.
10. 许威, 刘宏斌, 韩晓鹏, 等.腹腔镜胃癌根治术对高龄患者免疫功能及近期疗效的影响[J].中国现代普通外科进展, 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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