| ObjectiveAlthough slower to evolve than biliary surgery, laparoscopic resections have established their place as a minimally invasive approach applied to the diseases of the colon and rectum. Laparoscopic surgery provides tremendous benefits to patients, including faster recovery, shorter hospital stay, and prompter return to normal activities. Additionally, laparoscopic procedures provide better cosmesis, greater patient satisfaction. Polymorphonuclear leukocytes(PMN) play a central role in the host defense against invading pathogenic microorganisms. Conventional surgery has a major influence on postoperative PMN with reduced function in PMN reported. Because little is known about changes in PMN function after laparoscopic surgery, this research was designed to study expression of IL-6 and TNF-α, and respiratory burst in PMN.MethodsIn this study, 20 patients with rectal carcinoma were included and randomly assigned to undergo either a laparoscopic or conventional radical rectectomy. Each team included 10 patients. Peripheral venous blood samples were collected preoperatively (baseline), immediately, 24h and 72h after operation. Haematoglobin(HGB) and albumin(ALB) were measured. PMNs were harvested. Part of PMNs were counted and resuspended in DMEM with LPS (1μg/ml) at a concentration of 1×106cells/ml. These cells were incubated at the condition of 37 ℃, 5%C02/95%02 for 24h. The supernatant were collected after centrifugation and kept in -20 ℃ until measured. IL-6 and TNF-α were measured with enzyme-linked immunosorbent assay (ELISA) kit. The remaining part of PMN was used for assay of respiratory burst capacity.Results1. Change in nutritional state1) Haematoglobin (HGB): The values of HGB decreased postoperatively in both laparoscopic and open groups(P<0.05), compared with the basline. The minimum value ofHGB in laparoscopic group, 103.2±10.6g/L, appared immediately after operation. And the minimum in open group, 104.1±7.7g/L, came at postoperative 24h. There was significant difference in HGB between the two groups at postoperative 24h and 72h (P<0.05)2) Albumin (ALB): The values of ALB decreased postoperatively in both laparoscopic and open groups (P<0.01). The minimum values for both laparoscopic and open group appeared at postoperative 24h, and were 30.4±2.9g/L and 28.3±1.6g/L, respectively. There was no significant difference in ALB between the two groups immediately and 24h after operation (p>0.05). However, the value of ALB in open group was much lower than that in laparoscopic group 72h after surgery (P<0.01).2. Changes in white blood cell counts and the PMN respiratory burst capacity1) White blood cell (WBC): Compared with baseline, the count increased postoperatively and reached its peak, 13.3±1.0×l09/L, at postoperative 24h (P<0.01), and reduced to normal level at postoperative 72h in laparoscopic group. The count increased postoperatively and reached its peak, 15.1±0.8×109/L, at postoperative 24h (P<0.01), and reduced to 10.5±0.6×109/L, still higher than baseline, 72h after operation in open group. The count of WBC in open group was significantly higher than that in laparoscopic group, postoperatively (P<0.01).2) PMN: For laparoscopic group, the count increased postoperatively and reached its peak, 11.8±1.2×109/L, at postoperative 24h (P<0.01), and reduced to 5.6±0.6×109/L at postoperative 72h. For open group, the count increased postoperatively and reached its peak, 14.0±0.8×109/L, at postoperative 24h (P<0.Ol), and decreased to 7.7±0.6×109/L 72h after operation. The count of PMN in open group was obviously higher than that in laparoscopic group 24h and 72h after operation (P<0.01).3) PMN respiratory burst capacity: For laparoscopic group, compared with the baseline, the PMN respiratory burst capacity decreased postoperatively (P<0.05), and reduced to the minimum, 103.2±10.6g/L, 72h after operation. The indicator increased postoperatively in open group, without significant reduction compared with the baseline(P>0.05). However, there were significant differences in PMN respiratory burst capacity between laparoscopic group and open group at postoperative 24h and 72h (P<0.01)3. Changes of IL-6 and TNF-α expression by PMN1) IL-6 expression by PMN: IL-6 expression by PMN increased immediately and24h after operation with its peak, 198.8±11.8pg/ml, at postoperative 24h (P<0.01), and decreased to normal level 72h after operation in laparoscopic group. It increased immediately, 24h and 72h after surgery, with its peak, 243.1±10.3pg/ml, at postoperative 24h (P<0.01) in open group. There was significant difference between the two groups, postoperatively (P<0.01).2) TNF-α expression by PMN: TNF-α expression by PMN increased postoperatively, with its peak, 152.5±4.9pg/ml, at postoperative 24h (P<0.01), in laparoscopic group. The case was the same for open group with the peak, 179.1±6.2pg/ml, at postoperative 24h (p<0.01). There was significant difference between the two groups immediately and 24h after operation (P<0.01), and no significant difference at postoperative72h (P>0.05)Conclusion1. Compared with the conventional radical rectectomy, the aparoscopic procedure resulted in less influence on nutriture and a faster recovery.2. Compared with the open procedure, laparoscopic radical rectectomy resulted in reduced capacity of respiratory burst by PMN and less numbers of WBC and PMN, which lent laparoscopic procedure itself to less injury caused by non-specific inflammation.3. For laparoscopic radical rectectomy, PMNs showed decreased expression of IL-6 and TNF-α , compared with PMNs in open procedure. Therefore, the lower magnitude of nonspecific inflammatory injury by IL-6 and TNF-α was produced in laparoscopic procedure.In conclusion, with intensive anti-microorganism therapy, compared with conventional open procedure, laparoscopic procedure proved to produce the lower magnitude of surgery trauma, physiologic response and nonspecific inflammatory injury, more benefiting for patients to recover.
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