Himmelsbach Ruth, Landerer Anna, Hipp Julian, Hopt Ulrich T, Fichtner-Feigl Stefan, Wittel Uwe A, Ruess Dietrich A
Department of General and Visceral Surgery; Center for Surgery; Medical Center - University of Freiburg; Hugstetter Strasse 55, 79106 Freiburg, Germany.
Department of General and Visceral Surgery; Center for Surgery; Medical Center - University of Freiburg; Hugstetter Strasse 55, 79106 Freiburg, Germany.
Pancreatology. 2021 Aug;21(5):965-974. doi: 10.1016/j.pan.2021.03.014. Epub 2021 Mar 29.
Minimally invasive surgery is a field of rapid development. Evidence from randomized controlled trials in visceral surgery however still falls short of attesting unequivocal superiority to laparoscopic procedures over conventional open approaches with regard to postoperative outcome. The aim of this study was to explore the perioperative immune status of patients undergoing hybrid minimally invasive or conventional open pancreatoduodenectomy in a prospective cohort study.
Subtyping, quantification and functional analysis of circulating immune cells and determination of cytokine-levels in blood samples from patients receiving either hybrid minimally invasive (laPD) or conventional open pancreatoduodenectomy (oPD) was performed. Samples were taken from 29 patients (laPD: n = 14, oPD: n = 15) prior, during and up to six weeks after surgery. Cells were analyzed by flow cytometry, cytokines/chemokines were measured by proximity extension and enzyme-linked immunoassays.
Open surgery induced higher levels of circulating inflammatory CD14CD16 intermediate monocytes. In contrast, hybrid minimally invasive resection was accompanied by increased numbers of circulating regulatory CD4CD25CD127 T-cells and by a reduced response of peripheral blood CD3CD4 T-cell populations to superantigen stimulation. Yet, rates of postoperative morbidity and infectious complications were similar.
In summary, the results of this exploratory study may suggest a more balanced postoperative inflammatory response and a better-preserved immune regulation after hybrid minimally invasive pancreatoduodenectomy when compared to open surgery. Whether these results may translate to or be harnessed for improved patient outcome needs to be determined by future studies including larger cohorts and fully laparoscopic or robotic procedures.
微创手术是一个快速发展的领域。然而，内脏手术随机对照试验的证据仍不足以证明腹腔镜手术在术后结果方面比传统开放手术具有明确的优越性。本研究的目的是在前瞻性队列研究中探讨接受混合微创或传统开放胰十二指肠切除术患者的围手术期免疫状态。
对接受混合微创（laPD）或传统开放胰十二指肠切除术（oPD）患者的血液样本进行循环免疫细胞的亚型分析、定量分析和功能分析，并测定细胞因子水平。样本取自29例患者（laPD：n = 14，oPD：n = 15）手术前、手术期间及术后六周内。通过流式细胞术分析细胞，通过邻近延伸和酶联免疫测定法测量细胞因子/趋化因子。
开放手术诱导循环中炎性CD14CD16中间单核细胞水平升高。相比之下，混合微创切除伴随着循环调节性CD4CD25CD127 T细胞数量的增加以及外周血CD3CD4 T细胞群体对超抗原刺激的反应降低。然而，术后发病率和感染并发症的发生率相似。
总之，这项探索性研究的结果可能表明，与开放手术相比，混合微创胰十二指肠切除术后的炎症反应更平衡，免疫调节功能保留得更好。这些结果是否能转化为改善患者预后或用于改善患者预后，需要未来包括更大队列以及全腹腔镜或机器人手术的研究来确定。
