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Colorectal resections - clinical and immunological results

Vasil Kyosev, Elena Vikentieva Elefterova-Florova, Dora Nikolova Popova, Rositsa Hristova Vladimirova, Ventsislav Metodiev Mutafchiyski, Krasimir Vasilev, Plamen Ivanov, Grigor Grigorov, Georgi Kotashev, Georgi Popivanov, Vasilena Hristova, Hristo Petrov

Abstract

INTRODUCTION: Surgery induces a generalized state of postoperative immunosuppression responsible for a lot of complications in postoperative period. Magnitude and type of the intraoperative injury depend on the extent and duration of postoperative immune suppression. This study compared clinical outcomes and immune changes after minimally invasive and open colorectal resections in patients with colorectal cancer (CRC).

MATERIAL AND METHODS: Study included 40 patients with CRC who underwent colorectal resections in our clinic last year. Twenty one of them underwent minimally invasive surgery, with a mean age of 64.8 years (49-86). The rest 19 patients underwent conventional surgery, with a mean age of 66.2 years (56-84). Blood tests were performed 24 hours prior to surgery, 24 hours and 7 days after surgery. Analysis included full blood count, total protein, albumin and markers of inflammation (CRP, ESR, fibrinogen). T- (CD3+), B- (CD19+) and NK-cell lymphocyte populations were studied by means of flow cytometry, as well as activation of leucocytes, according to the expression of HLA-DR, CD38, CD279, CD163 and some clinical parameters. All data were analyzed using SPSS version 21.

RESULTS: There was no significant difference in preoperative results between minimally invasive group and conventional group. At 24 hours after surgery there were significant decrease in lymphocyte percentages and increased leucocyte count, granulocyte percentages and CRP levels in conventional group. This ratio maintained at 7 days after surgery. Activated monocyte (CD 163+), total protein and albumin, eosinophiles, percentage of monocytes, lymphocytes and NKT-cells (CD3+ CD16/CD56+) were significant decrease in conventional group compared with minimally invasive group at first postoperative day.

CONCLUSIONS: Minimally invasive colorectal cancer resection is a technically feasible option, with comparable results in terms of oncologic clearance, lesser degrees of tissue injury, surgical metabolic stress, and immunosuppressive response to conventional open surgery. Patients undergoing minimally invasive resections demonstrated improved clinical recovery and shorter hospital stay than patients undergoing open surgery.   


Keywords

minimally invasive surgery; postoperative immunosuppression; surgical metabolic stress

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DOI: http://dx.doi.org/10.14748/ssm.v1i1.1507

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About The Authors

Vasil Kyosev
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Elena Vikentieva Elefterova-Florova
Section of Clinical Immunology, Military Medical Academy

Dora Nikolova Popova
Section of Clinical Immunology, Military Medical Academy

Rositsa Hristova Vladimirova
Section of Clinical Immunology, Military Medical Academy

Ventsislav Metodiev Mutafchiyski
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Krasimir Vasilev
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Plamen Ivanov
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Grigor Grigorov
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Georgi Kotashev
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Georgi Popivanov
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Vasilena Hristova
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

Hristo Petrov
Clinic of Endoscopic, Endocrine surgery and Coloproctology, Military Medical Academy

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