Immune Response After Total Mesorectal Excision & Anal Sphincter Preservation For Rectal Cancer With Minimal Invasive Surgery

Immune response after total mesorectal excision & anal sphincter preservation for rectal cancer with minimal invasive surgeryAIM This study was designed to compare immune function after laparoscopic and open total mesorectal excision & anal sphincter preservation for rectal cancer, and to assess the immune response in patients undergoing total mesorectal excision for rectal cancer with minimal invasive surgery.METHODS This study involved 45 patients undergoing laparoscopic(n=20) and open(n=25) total mesorectal excision & anal sphincter preservation for rectal cancer, and 30 healthy individuals for normal control. Interleukin-2(IL-2), Interleukin-6(IL-6), and tumor necrosis factor a (TNFa) were assayed preoperatively and on the 1st and 5th postoperative day. CD3+ CD56+ T lymphocyte count, CD3 CD56+ natural killer cell (NK) count and immunoglobulin (IgG/IgM/IgA) were assayed preoperatively and at 5 day postoperatively. The numbers of CD3+ CD56+ T lymphocyte and CD3- CD56+ NK cell were counted using flowcytometry. An enzyme-linkedimmunosorbent assay was used for IL-2, IL-6 and TNF determination. Immunoglobulin was tested with Immage analyzer by immuno-scattering turbidimetry.RESULTS The levels of CD3- CD56+ NK cell, IL-6 and IgA were demonstrated higher in patients with rectal cancer than those in healthy control. Significant decreases in NK and IgG were revealed within 5 day postoperatively in open group (p<0.05) . IgG was decreased within 5 day postoperatively in laparoscopic group (p<0.05 ) . The other parameters had no significant change (p>0.05) perioperatively. No significant difference of immune response between the open and laparoscopic groups was seenCONCLUSION Patients with rectal cancer reveal immune depression, and exhibit significant perioperative immune disturbance with laparoscopic and open surgery. There is no difference in immune responses in patients having laparoscopic total mesorectal excision & anal sphincter preservation compared with those undergoing open surgery for rectal cancer.