Minimal modulation of lymphocyte and natural killer cell subsets following minimal access surgery

• Published in: The American journal of surgery Vol. 177; no. 1; pp. 48 - 54
• Main Authors: Walker, Catrı̀ona B.J, Bruce, Duff M, Heys, Steven D, Gough, David B, Binnie, Norman R, Eremin, Oleg
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 1999; Elsevier; Elsevier Limited
• Subjects: Adult; Analgesics; Biological and medical sciences; CD11b antigen; CD16 antigen; CD3 antigen; CD4 antigen; CD56 antigen; CD57 antigen; CD8 antigen; Cholecystectomy; Cholecystectomy, Laparoscopic; Cholecystitis - immunology; Cholecystitis - surgery; Cholelithiasis - immunology; Cholelithiasis - surgery; Female; Flow Cytometry; Humans; Immune response; Immune response (cell-mediated); Immune system; Immunomodulation; Immunosuppression; Killer Cells, Natural - immunology; Laparoscopy; Liver, biliary tract, pancreas, portal circulation, spleen; Lymphocyte Activation - immunology; Lymphocyte Count; Lymphocytes; Lymphocytes T; Male; Medical sciences; Metabolism; Middle Aged; Minimally Invasive Surgical Procedures; Modulation; Monoclonal antibodies; Morphine; Natural killer cells; Nonsteroidal anti-inflammatory drugs; Patients; Postoperative Complications - immunology; Postoperative period; Prospective Studies; Rehabilitation; Surface markers; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; T-Lymphocyte Subsets - immunology; Cholecystectomy; Human; Immune response; Minimization; Laparoscopy; Result; Natural killer cell; Prospective; Treatment; Surgery; Modulation; Surgical approach; Gallbladder; Endoscopy; Technique; Laparotomy; Lymphocyte
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/S0002-9610(98)00290-6

Background: Trauma, whether accidental or surgically induced, is known to cause significant modulation of the cell-mediated immune response. Minimal access surgery (MAS) has been shown to improve postoperative recovery and enhance rehabilitation. The degree of immunosuppression resulting from two MAS techniques was studied and compared by measuring the circulating T lymphocyte and natural killer (NK) cell subsets.
Method: This investigation was a randomized prospective study of patients admitted to the Professorial Surgical Unit, Aberdeen Royal Infirmary for elective cholecystectomy. Two methods of MAS were studied—laparoscopy and minilaparotomy.
Results: Laparoscopy was found to cause significantly less reduction in the number of cells expressing T lymphocyte phenotypic surface markers (CD2, CD3, CD8, CD4:CD8 ratio), activation markers (CD71 and HLA-DR), and NK cell subsets (CD11b, CD16, CD56 and CD57), when compared with the minilaparotomy technique.
Conclusions: These data show that host defences are less suppressed after laparoscopic cholecystectomy, and this may have important implications for the use of laparoscopic techniques in major surgical resections, especially for malignant disease.