Department of Surgery, VU University Medical Center, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands,
World J Surg. 2014 Jan;38(1):131-7. doi: 10.1007/s00268-013-2233-0.
This study was performed as a substudy analysis of a randomized trial comparing conventional open esophagectomy [open surgical technique (OE)] by thoracotomy and laparotomy with minimally invasive esophagectomy [minimally invasive procedure (MIE)] by thoracoscopy and laparoscopy. This additional analysis focuses on the immunological changes and surgical stress response in these two randomized groups of a single center.
Patients with a resectable esophageal cancer were randomized to OE (n = 13) or MIE (n = 14). All patients received neoadjuvant chemoradiotherapy. The immunological response was measured by means of leukocyte counts, HLA-DR expression on monocytes, the acute-phase response by means of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8), and the stress response was measured by cortisol, growth hormone, and prolactin. All parameters were determined at baseline (preoperatively) and 24, 72, 96, and 168 h postoperatively.
Significant differences between the two groups were seen in favor of the MIE group with regard to leukocyte counts, IL-8, and prolactin at 168 h (1 week) postoperatively. For HLA-DR expression, IL-6, and CRP levels, there were no significant differences between the two groups, although there was a clear rise in levels upon operation in both groups.
In this substudy of a randomized trial comparing minimally invasive and conventional open esophagectomies for cancer, significantly better preserved leukocyte counts and IL-8 levels were observed in the MIE group compared to the open group. Both findings can be related to fewer respiratory infections found postoperatively in the MIE group. Moreover, significant differences in the prolactin levels at 168 h after surgery imply that the stress response is better preserved in the MIE group. These findings indicate that less surgical trauma could lead to better preserved acute-phase and stress responses and fewer clinical manifestations of respiratory infections.
本研究是一项随机试验的亚组分析，该试验比较了传统的开胸食管癌切除术[开胸手术技术（OE）]与微创食管切除术[微创程序（MIE）]，通过胸腔镜和腹腔镜。这项额外的分析集中在这两个随机组的一个单一中心的免疫变化和手术应激反应。
将可切除的食管癌患者随机分为 OE 组（n = 13）或 MIE 组（n = 14）。所有患者均接受新辅助放化疗。通过白细胞计数、单核细胞 HLA-DR 表达、C 反应蛋白（CRP）、白细胞介素-6（IL-6）和白细胞介素-8（IL-8）来衡量免疫反应，通过皮质醇、生长激素和催乳素来衡量应激反应。所有参数均在基线（术前）和术后 24、72、96 和 168 小时测定。
与 OE 组相比，MIE 组在术后 168 小时（1 周）的白细胞计数、IL-8 和催乳素方面有显著差异。对于 HLA-DR 表达、IL-6 和 CRP 水平，两组之间没有显著差异，尽管两组在手术后水平都明显升高。
在这项比较微创和传统开胸食管癌切除术治疗癌症的随机试验的亚组研究中，与开胸组相比，MIE 组的白细胞计数和 IL-8 水平明显得到更好的保护。这两种发现都可以与 MIE 组术后发现的呼吸道感染较少有关。此外，手术后 168 小时催乳素水平的显著差异意味着 MIE 组的应激反应得到更好的保护。这些发现表明，手术创伤较小可能导致更好地保护急性期和应激反应，并减少呼吸道感染的临床表现。
