Immunological aspects of minimally invasive oncologic surgery

In the last few decades minimally invasive surgery has evolved to complement more traditional open surgical approaches. Pioneers of laparoscopic surgery have continually striven to replicate open surgical techniques with a view to maintaining equivalent surgical outcomes with the added benefits of shorter hospital stays, earlier return to full activity and fewer long-term wound complications. Having established the safety and feasibility of minimally invasive surgery, the focus moved to assuring such surgeries had equivalence in terms of oncological outcomes. Currently there is interest in exploring areas where laparoscopy might provide advantages over open surgery. The effect on immune response following surgery and how it relates to oncological outcomes is one potential area, and is reviewed here.

Major surgery is associated with profound alterations in host immunity, with an initial elevation in cytokine production giving way to a compensatory anti-inflammatory response. This suppresses normal defence mechanisms rendering the host more susceptible to infection, dampening immune defence mechanisms active in malignancy. Minimally invasive surgery is associated with better preservation of systemic immune responses following major surgery.

Laparoscopy results in better overall preservation of immune function than open surgery. There is, however, depression of local immune responses locally at the level of the peritoneum. Whether findings in the experimental animal translate into true benefit for patients remains to be seen.