Immunological advantages of advanced laparoscopy

Surgical trauma clearly results in deleterious alterations in immune function. The bulk of the available data suggests that minimally invasive methods, when compared with results following open procedures, are associated with significantly less pronounced perturbations in immune function. This is true for a number of pro-inflammatory cytokines, acute-phase proteins, DTH response, and at least one growth-regulatory factor. There are conflicting data, however, concerning many of these parameters, and it is critical to note that the documented postoperative alterations have not been definitely associated with specific complications or differences in clinical outcomes. It is possible that improved overall immune function following laparoscopic surgery accounts for some of the short-term clinical benefits that have been well documented. Laparotomy clearly impacts postoperative tumor growth in the experimental setting. This may or may not be related to surgery-related changes in immune function. There are clinical data demonstrating alterations in levels and activity of some serum growth factors following surgery that may also impact on postoperative tumor growth. Overall, evaluation of perioperative immune function warrants further investigation. Further studies should provide us with a better understanding of the impact of surgery on the host, and hold the promise of new therapeutic targets and pharmacologic methods to manipulate the host immune response perioperatively so as to minimize complications, and perhaps improve long-term oncologic results in the setting of cancer.