Effects Of Cellular Immunity After Laparoscopic And Open Radical Operation For Advanced Gastric Cancer

Object: It is still a controversial issue when treat the advanced gastric cancer with laparoscopic,owing to the difficultly of the operation, lacking of a prospective multicenter randomized controlled trial and the fettering by traditional idea. Therefore this study to compare index of cellularimmune after laparoscope and open radical operation for advanced gastric cancer, to explainwhether laparoscopy in the treatment of advanced gastric carcinoma can show the real minimallyinvasive therapeutic effect.Methods: In the study,64patients of advanced gastric carcinoma were treated in our hospitalduring October2009to April2013.They all been diagnosised of gastric cancer by endoscopy andpathological biopsy before the operation, without distant metastasis,without the history ofchemotherapy and immune therapy.Of course,they must be the one has operation indications andcan be curative resection. In addition, they must be diagnosed gastric cancer in Ib-II (depth oftumor invasion than in T2) by pathology after the surgey. The patients were divided to two group,laparoscopy group (31cases) and laparotomy group (33cases).We analysis the dates of CD3+(%),CD4+(%), CD8+(%), CD4+/CD8+and the level of NK cells before and after the surgery.Results:1. There are31cases of laparoscopic group,23cases of male,8cases of female; age(62.1±7.9) years;26cases of total gastrectomy,5cases of distal gastrectomy;4cases of Ib,16cases of IIa,11cases of IIb. there are33cases of laparoscopic group,26cases of male,7cases offemale; age (65.1±9.2) years;27cases of total gastrectomy,6cases of distal gastrectomy;3casesof Ib,17cases of IIa,13cases of IIb. There are no statistical difference between two groups in agestructure, sex ratio, gastric resection range of cases, TNM stage, P>0.05.2. laparoscopy group: Operation time (time of Anesthesia started to anesthesia decannulation)(272.1±51.9min), peri-operative bleeding (113.0±16.4ml), number of the average cleaned lymphnodes(21.8±9.2), time of anal exhaust (4.0±0.5)days, postoperative activity time (4.0±0.5)days;open group: Operation time (time of Anesthesia started to anesthesia decannulation)(209.8±16.4min), peri-operative bleeding(220.0±19.1ml), number of the average cleaned lymphnodes(24.3±6.7), time of anal exhaust(5.0±0.5), postoperative activity time (5.5±1.0)days. Thereindexes have statistieal difference between two groups, P <0.05).3. The changes and comparison of CD3+(%), CD4+(%),CD4+/CD8+:(1)In the two groups,these indexes present a downward trend after the surgery, have a rebound trend on postoperative7th day, and returned to preoperative levels or on postoperative14th day. They have statisticaldifference between preoperative day and postoperative day, postoperative3rd day and postoperative7th day, P <0.05; and comparison of postoperative day and postoperative3rd day isno statistical difference, P>0.05.(2)On preoperative, postoperative day, and postoperative3rd day,the comparison between the CD3+(%), CD4+(%), CD4+/CD8+of two groups at the same timepoints, were no significant difference, P>0.05; but on postoperative7th day and postoperative14th day, the comparison have statistical difference P <0.05.4. The changes and comparison of CD56+(%), CD8+(%):(1) In the two groups, these indexespresent a downward trend after the surgery, on postoperative7th day have a rebound trend, andreturned to preoperative levels on postoperative14th day. They have significant difference betweenpreoperative day and postoperative day, postoperative7th day and postoperative14th day,postoperative14th day and preoperative day, P <0.05; but, there was no significant differencecompared with postoperative day and postoperative3rd day, postoperative3rd day andpostoperative3rd day, P>0.05.(2) The change of CD8+(%) in the two groups betweenpreoperative and a postoperative is no significant difference, P>0.05; CD8+(%) and CD56+(%)between the two groups in the same point are also no significant difference, P>0.05.Conclusion:1.The cellular immunity is suppressed both by gastric cancer radical operation ofopen and laparoscopic.2.Through the whole process of open and laparoscopic radical resection ofgastric cancer, the degrees of inhibition to cellular immunity are similar.3.Laparoscopic radicalgastrectomy for gastric cancer is more beneficial to recovered of cell immune suppression.Laparoscopic advantage embodied in the postoperative recovery.