Pro-inflammatory cytokine release in rectal surgery: comparison between laparoscopic and open surgical techniques

The objective of the present study was to investigate whether laparoscopic rectal surgery causes a less pronounced release of pro-inflammatory cytokines as compared to open surgical technique. Twenty-four consecutive patients undergoing rectal surgery due to cancer disease were included in a prospective and randomized trial. The patients were randomized to laparoscopic (n = 12) or open surgery (n = 12). Blood was sampled at five occasions; after induction of anesthesia before start of surgery, at 180, 360 min and 24 h after start of surgery and the last sample was taken in the late post-operative period 3-5 days after surgery. The levels of interleukin (IL)-1α, IL-6, IL-8, IL-10, tumor necrosis factor-α, C-reactive protein (CRP), white blood cells, intracellular adhesion molecule-1 and vascular cell adhesion molecule-1 were analyzed using multiplex sandwich enzyme-linked immunosorbent assay. There was a release of both pro- and anti-inflammatory cytokines during colorectal surgery. The release of IL-6, IL-10 and CRP was significantly lower in the laparoscopic group. Rectal surgery causes release of both pro- and anti-inflammatory cytokines. The inflammatory response is lower in laparoscopic rectal surgery as compared to conventional open surgery. Less tissue trauma in laparoscopic rectal surgery and/or less peri-operative bleeding in the laparoscopic cases leads to a lower degree of inflammatory response.