Colorectal Surgery Unit, Department of Surgery, Hospital del Mar, Barcelona, Spain.
Br J Surg. 2011 Jan;98(1):50-9. doi: 10.1002/bjs.7258. Epub 2010 Aug 26.
Several studies have suggested that laparoscopy might confer an oncological advantage in patients undergoing surgery for colonic cancer. A decreased inflammatory and angiogenic response has been proposed. This study compared the local and systemic inflammatory and angiogenic responses after open and laparoscopic surgery for colonic cancer.
Some 122 patients with colonic cancer were randomized to open or laparoscopic colectomy. Levels of interleukin (IL) 6 and vascular endothelial growth factor (VEGF) were measured in serum and peritoneal fluid at baseline, then at 4, 12, 24 and 48 h and on day 4 after surgery. Samples obtained on day 4 were tested in an in vitro angiogenesis assay, with measurement of number of capillaries per field and capillary length.
The serum IL-6 level was lower in the laparoscopic group at 4 h (mean(s.d.) 124(110) versus 244(326) pg/dl after open colectomy; P = 0·027). The serum VEGF concentration was also lower in the laparoscopic group at 48 h and day 4 (430(435) versus 650(686) pg/dl; P = 0·001). Overall, local IL-6 and VEGF levels were significantly higher than serum levels but there were no differences between groups. In vitro, postoperative serum and peritoneal fluid samples were potently angiogenic but there were no differences between open surgery and laparoscopy. Rates of tumour recurrence and survival were similar in the two groups.
Despite differences in postoperative serum levels of IL-6 and VEGF after open and laparoscopic surgery in patients with colonic cancer, the angiogenic response is comparable in both surgical approaches.
ISRCTN55624793 (http://www.controlled-trials.com).
几项研究表明，腹腔镜手术可能在结肠癌患者的手术中带来肿瘤学优势。有人提出，腹腔镜手术会降低炎症和血管生成反应。本研究比较了开腹和腹腔镜结肠癌手术的局部和全身炎症及血管生成反应。
122 例结肠癌患者随机分为开腹组或腹腔镜组。在基线、术后 4、12、24 和 48 小时以及术后第 4 天测量血清和腹腔液中白细胞介素（IL）6 和血管内皮生长因子（VEGF）的水平。第 4 天采集的样本在体外血管生成测定中进行检测，测量每视野的毛细血管数和毛细血管长度。
腹腔镜组在术后 4 小时时血清 IL-6 水平较低（开腹 colectomy 组为 124(110)pg/dl，腹腔镜组为 244(326)pg/dl；P=0·027）。腹腔镜组术后 48 小时和第 4 天的血清 VEGF 浓度也较低（430(435)pg/dl，腹腔镜组为 650(686)pg/dl；P=0·001）。总体而言，局部 IL-6 和 VEGF 水平明显高于血清水平，但两组之间没有差异。体外实验中，术后血清和腹腔液样本具有明显的血管生成能力，但开腹手术和腹腔镜手术之间没有差异。两组的肿瘤复发率和生存率相似。
尽管开腹和腹腔镜结肠癌手术后患者的血清 IL-6 和 VEGF 水平存在差异，但两种手术方式的血管生成反应相似。
ISRCTN55624793（http://www.controlled-trials.com）。
