Colorectal Surgery

There Immune Benefits to Laparoscopic Colorectal Surgery?

A Consequence Of Those Early Concerns Was An Increasing Interest In Understanding The Physiologic Consequences Of Surgery, Both Open And Laparoscopic, And Its Effects On Tumor Biology And Immune Function. It Is Well Known That Surgery Leads To Transient Immunosuppression, Though The Underlying Etiology Remains Unclear. A Well-Known Cascade Of Physiologic And Immunologic Responses Occurs After Surgery. Inflammation Involves The Recruitment Of Macrophages And Neutrophils At Sites Of Tissue Injury, Release Of Proinflammatory Cytokines And Growth Factors To Promote Wound Healing (And That May Also Stimulate Tumor Growth), And Activation Of T Cell (Cellular) And B Cell (Humoral) Immunity.

Surgery Has Been Shown To Dampen Each Of These Responses, Leading To Varying Degrees Of Immunosuppression. Laparoscopic Surgery, Which Is Associated With Less Patient Trauma Through Smaller Incisions And Less Postoperative Pain, May Be Associated With Less Immunosuppression, Compared With Open Surgery, Though The Data Remain A Subject Of Debate And The Clinical Significance Of This Effect Remains Unclear.

Experimental Models By Colon Surgeons Have Demonstrated Differences In The Function Of Macrophage, Neutrophil, Lymphocyte, And T Cell Populations, Differences In The Level Of Secreted Pro-Inflammatory Cytokines (Interleukin 6, Tumor Necrosis Factor), And Alterations In Delayed-Type Hypersensitivity (An Indicator Of Cell-Mediated Immunity) Comparing Laparoscopic And Open Techniques.

In Other Models, Stimulation Of Tumor Growth Or Metastases After Surgery Has Been Shown To Be Reduced In Laparoscopically Treated Patients Compared With Those Who Underwent Open Surgery. This Could Possibly Be Due To Differences In The Levels Of Angiogenic/Growth Factors Secreted At The Time Of Surgery. Vascular Endothelial Growth Factor Is A Potent Angiogenesis Factor, And Serum Levels Are Elevated In Patients With Colon Cancer. In A Study By Belizon Et Al, Patients Who Underwent Surgery For Colon Cancer Had Further Elevations In Serum Vascular Endothelial Growth Factor Levels During The Early Postoperative Period.15 The Increase Occurred Earlier, And Was More Profound, In Patients Having Open Surgery Compared With Laparoscopically Treated Patients. Levels Also Increased In Proportion To Incision Length. Insulin And Insulin-Like Growth Factor Are Also Associated With Tumor Growth; Elevated Levels May Place Patients At Increased Risk For The Development Of Colon Cancer. Studies Have Demonstrated Lower Levels Of The Tumor Inhibitor Insulin-Like Growth Factor Binding Protein 3 In Patients Having Open Surgery, Whereas No Decrease Was Seen In Laparoscopically Treated Patients.

To Date, No Survival Differences Have Been Found Comparing Cancer Patients Treated By The Open Method And Those Treated Laparoscopically; However, Some Intriguing Trends Have Been Seen In Smaller Studies Conducted By Various Colon Surgeons. Systemic Immune Function And Tumor Growth May Be Differentially Regulated By The Degree Of Surgical Trauma. Though The Clinical Impact Of These Findings Is Uncertain, The Concept Certainly Warrants Further Study.

Systemic Immune Function And Tumor Growth May Be Differentially Regulated By The Degree Of Surgical Trauma.

How Is Laparoscopic Colectomy Done by a Colon Surgeon?

The Technique Of Laparoscopic Colectomy Has A Long Learning Curve For Every Colon Surgeon Because Of The Advanced Laparoscopic Skills It Entails. Unlike Other Laparoscopic Procedures, Such As The Nissen Fundoplication Or Cholecystectomy, Colorectal Procedures Involve Dissection And Mobilization Of Intra-Abdominal Organs In Multiple Quadrants. Laparoscopic Colorectal Surgery Involves The Use Of Several Small Incisions Through Which A Specialized Camera And Several Laparoscopic Instruments. An Insufflator Blows Carbon Dioxide (CO2) Into The Peritoneal Cavity, Creating A Pneumoperitoneum That Provides A Working Space To Perform The Operation. Tilting Of The Operating-Room Table In Various Positions During An Operation Uses Gravity To Allow Intra-Abdominal Organs To Fall Away From The Area Of Dissection, Providing Necessary Exposure That Would Normally Be Achieved Through The Use Of Retractors. Intestinal Resection Requires Laparoscopic Ligation Of Large Vessels, Mobilization And Removal Of A Long Floppy Segment Of Colon, And Restoration Of Intestinal Continuity. Once The Colon Segment Has Been Completely Mobilized And Its Blood Supply Divided, A Small Skin Incision Is Made To Exteriorize The Colon, A Resection And Anastomosis Are Performed Extracorporeally, And The Rejoined Colon Is Placed Back Into The Abdomen.

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