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Cell-mediated immune response is better preserved by laparoscopy than laparotomy
Insights
Carbon dioxide pneumoperitoneum preserves cellular immunity better than laparotomy or extraperitoneal incisions. This immune response was measured by delayed-type hypersensitivity skin reactions and tumor rejection in mice.
Area of Science:
- Immunology
- Surgical Oncology
- Anesthesiology
Background:
- Surgical procedures can impact the immune system.
- Carbon dioxide pneumoperitoneum is a common insufflation gas used in minimally invasive surgery.
Purpose of the Study:
- To compare the effects of carbon dioxide pneumoperitoneum versus laparotomy on cellular-mediated immune response.
- To evaluate the impact of different surgical approaches on the body's ability to mount an immune response.
Main Methods:
- Sixty-eight female C3H/He mice were sensitized to keyhole limpet hemocyanin (KLH) and a mouse mammary carcinoma cell line (MC2).
- Mice were randomized into four groups: anesthesia, carbon dioxide pneumoperitoneum, extraperitoneal wound, and laparotomy.
- Postoperative cellular immune response was assessed using delayed-type hypersensitivity (DTH) skin reactions to KLH and tumor growth of MC2 cells.
Main Results:
- Postoperative DTH skin reactions were significantly reduced in the laparotomy and extraperitoneal wound groups compared to controls.
- Carbon dioxide pneumoperitoneum group showed a less pronounced reduction in DTH reactions compared to laparotomy.
- Tumor growth was significantly increased in the laparotomy group compared to anesthesia and carbon dioxide pneumoperitoneum groups.
Conclusions:
- Cellular immunity is better preserved following carbon dioxide pneumoperitoneum compared to laparotomy.
- Minimally invasive surgery using carbon dioxide pneumoperitoneum may have a less detrimental effect on immune function than open laparotomy.
- These findings suggest that surgical approach can influence postoperative immune surveillance and tumor control.
Background:
This study compares the effects of carbon dioxide pneumoperitoneum versus laparotomy on cellular-mediated immune response in a murine model.
Methods:
Sixty-eight female C3H/He mice were sensitized to keyhole limpet hemocyanin (KLH) and to a mouse mammary carcinoma cell line (MC2) before surgery. Animals were randomized into 4 groups: group I, anesthesia (control); group II, pneumoperitoneum with carbon dioxide; group III, extraperitoneal wound; group IV, laparotomy. All animals were challenged subsequently with KLH and MC2 tumor cells. Delayed-type hypersensitivity skin reaction (DTH) to KLH was measured on postoperative days (PODs) 1, 2, 4, and 5. Tumor growth was assessed weekly as an indicator of postoperative cellular immune response.
Results:
Compared with preoperative values, postoperative DTH skin reactions were significantly less for all PODs in groups III and IV (P < .05), on POD 1 and 4 in group II (P < .05) and POD 4 for group I (P < .05). Group IV showed significantly fewer DTH skin reactions for all PODs compared with groups I and II (P < .05) and all PODs except on day 2 compared with group III (P < .05). Tumor growth was significantly increased at postoperative week 2 (n = 3/17 mice) and 3 (n = 4/17 mice) in group IV, when compared with groups I and II (P < .05).
Conclusions:
Cellular immunity is preserved after carbon dioxide pneumoperitoneum compared with extraperitoneal incisions and laparotomy as measured by DTH and the ability to reject an immunogenictumor.
