Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis
Colorectal cancer (CRC) is the third most common cancer worldwide. The main treatment options are laparoscopic (LS) and open surgery (OS), which might differ in their impact on the cellular immunity so indispensable for anti-infectious and antitumor defense. MEDLINE, Embase, Web of Science (SCI-EXPA...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-06-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/15/13/3381 |
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| author | Annika Bohne Elena Grundler Helge Knüttel Alois Fürst Vinzenz Völkel |
| author_facet | Annika Bohne Elena Grundler Helge Knüttel Alois Fürst Vinzenz Völkel |
| author_sort | Annika Bohne |
| collection | DOAJ |
| description | Colorectal cancer (CRC) is the third most common cancer worldwide. The main treatment options are laparoscopic (LS) and open surgery (OS), which might differ in their impact on the cellular immunity so indispensable for anti-infectious and antitumor defense. MEDLINE, Embase, Web of Science (SCI-EXPANDED), the Cochrane Library, Google Scholar, ClinicalTrials.gov, and ICTRP (WHO) were systematically searched for randomized controlled trials (RCTs) comparing cellular immunity in CRC patients of any stage between minimally invasive and open surgical resections. A random effects-weighted inverse variance meta-analysis was performed for cell counts of natural killer (NK) cells, white blood cells (WBCs), lymphocytes, CD4+ T cells, and the CD4+/CD8+ ratio. The RoB2 tool was used to assess the risk of bias. The meta-analysis was prospectively registered in PROSPERO (CRD42021264324). A total of 14 trials including 974 participants were assessed. The LS groups showed more favorable outcomes in eight trials, with lower inflammation and less immunosuppression as indicated by higher innate and adaptive cell counts, higher NK cell activity, and higher HLA-DR expression rates compared to OS, with only one study reporting lower WBCs after OS. The meta-analysis yielded significantly higher NK cell counts at postoperative day (POD)4 (weighted mean difference (WMD) 30.80 cells/µL [19.68; 41.92], <i>p <</i> 0.00001) and POD6–8 (WMD 45.08 cells/µL [35.95; 54.21], <i>p <</i> 0.00001). Although further research is required, LS is possibly associated with less suppression of cellular immunity and lower inflammation, indicating better preservation of cellular immunity. |
| first_indexed | 2024-03-11T01:45:01Z |
| format | Article |
| id | doaj.art-3eee70569c854c0b97754733bd128ef9 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-11T01:45:01Z |
| publishDate | 2023-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-3eee70569c854c0b97754733bd128ef92023-11-18T16:16:11ZengMDPI AGCancers2072-66942023-06-011513338110.3390/cancers15133381Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-AnalysisAnnika Bohne0Elena Grundler1Helge Knüttel2Alois Fürst3Vinzenz Völkel4Fakultät für Medizin, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, GermanyFakultät für Medizin, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, GermanyUniversitätsbibliothek Regensburg, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, GermanyCaritas Krankenhaus St. Josef Regensburg, Klinik für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053 Regensburg, GermanyTumorzentrum Regensburg—Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053 Regensburg, GermanyColorectal cancer (CRC) is the third most common cancer worldwide. The main treatment options are laparoscopic (LS) and open surgery (OS), which might differ in their impact on the cellular immunity so indispensable for anti-infectious and antitumor defense. MEDLINE, Embase, Web of Science (SCI-EXPANDED), the Cochrane Library, Google Scholar, ClinicalTrials.gov, and ICTRP (WHO) were systematically searched for randomized controlled trials (RCTs) comparing cellular immunity in CRC patients of any stage between minimally invasive and open surgical resections. A random effects-weighted inverse variance meta-analysis was performed for cell counts of natural killer (NK) cells, white blood cells (WBCs), lymphocytes, CD4+ T cells, and the CD4+/CD8+ ratio. The RoB2 tool was used to assess the risk of bias. The meta-analysis was prospectively registered in PROSPERO (CRD42021264324). A total of 14 trials including 974 participants were assessed. The LS groups showed more favorable outcomes in eight trials, with lower inflammation and less immunosuppression as indicated by higher innate and adaptive cell counts, higher NK cell activity, and higher HLA-DR expression rates compared to OS, with only one study reporting lower WBCs after OS. The meta-analysis yielded significantly higher NK cell counts at postoperative day (POD)4 (weighted mean difference (WMD) 30.80 cells/µL [19.68; 41.92], <i>p <</i> 0.00001) and POD6–8 (WMD 45.08 cells/µL [35.95; 54.21], <i>p <</i> 0.00001). Although further research is required, LS is possibly associated with less suppression of cellular immunity and lower inflammation, indicating better preservation of cellular immunity.https://www.mdpi.com/2072-6694/15/13/3381laparoscopyopen surgerysurgical stress responsecellular immunitynatural killer cellslymphocytes |
| spellingShingle | Annika Bohne Elena Grundler Helge Knüttel Alois Fürst Vinzenz Völkel Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis Cancers laparoscopy open surgery surgical stress response cellular immunity natural killer cells lymphocytes |
| title | Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis |
| title_full | Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis |
| title_fullStr | Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis |
| title_short | Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis |
| title_sort | influence of laparoscopic surgery on cellular immunity in colorectal cancer a systematic review and meta analysis |
| topic | laparoscopy open surgery surgical stress response cellular immunity natural killer cells lymphocytes |
| url | https://www.mdpi.com/2072-6694/15/13/3381 |
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