Robot-Assisted Colorectal Cancer Surgery Mitigates Early Postoperative Immunosuppression and Angiogenesis

Area of Science:

• Immunology
• Surgical Oncology
• Molecular Biology

Background:

• Minimally invasive surgery (MIS) reduces postoperative stress but its molecular impact on immunity and cancer is unclear.
• Open surgery (OS) and robot-assisted surgery (RS) have different effects on the immune system.
• Understanding these differences is crucial for optimizing cancer treatment and patient recovery.

Purpose of the Study:

• To compare the perioperative immune and inflammatory responses between robot-assisted surgery (RS) and open surgery (OS) in colorectal cancer patients.
• To investigate the molecular mechanisms underlying immune modulation by different surgical approaches.
• To assess the impact of surgical technique on immune balance, angiogenesis, and tumor-promoting factors.

Main Methods:

• Sixty-one colorectal cancer patients underwent either RS (n=30) or OS (n=31).
• Blood samples were collected pre-surgery and at 8, 24, and 72 hours post-surgery.
• Multiplex immunoassays and mass spectrometry measured cytokines, growth factors, and prostanoids.

Main Results:

• RS induced stronger Th1-associated cytokine activation (e.g., IFNγ, IP-10), indicating enhanced cellular immunity.
• RS led to smaller, transient increases in immunosuppressive Th2 cytokines (e.g., IL-4, IL-10) compared to broader, sustained elevations after OS.
• RS resulted in lower, faster-resolving pro-angiogenic factors (VEGF-A, PDGF-BB, FGF2) and prostaglandins (PGE₂, PGF₂α) compared to OS.

Conclusions:

• Robot-assisted surgery is associated with reduced perioperative inflammatory and immunosuppressive activity compared to open surgery.
• RS promotes a faster recovery of immune balance and diminishes pro-angiogenic and tumor-promoting signals.
• These findings suggest RS may offer a protective effect against pathogens and cancer recurrence after colorectal tumor resection.