Original Articles
Downregulation of T helper type 1 immune response and altered pro-inflammatory and anti-inflammatory T cell cytokine balance following conventional but not laparoscopic surgery1

https://doi.org/10.1016/S0002-9610(98)00299-2Get rights and content

Abstract

Background: The clinical advantages of laparoscopic procedures result from a minimized surgical trauma. The present study was performed to investigate immunosupression following laparoscopic operations as compared with open surgery. Our analysis focused on the T cell secretion of cytokines that regulate the critical balance of either T helper type-1 (Th1)- and Th2-mediated immune responses on pro- and anti-inflammatory activities.

Methods: In a prospective study, immunological data of 26 patients submitted to laparoscopic cholecystectomy (LCE) and 17 patients undergoing conventional cholecystectomy (CCE) for symptomatic cholecystolithiasis were compared. Patients with acute cholecystitis and patients developing postoperative complications or receiving immunosuppressive medication were excluded. Production of interferon (IFN)-γ, interleukin (IL)-2, IL-4, tumor necrosis factor (TNF)-α, and IL-10 by isolated T cells stimulated by cross-linking of CD3 and CD28 was evaluated preoperatively as well as on postoperative days 1 and 6 or 7. Cytokines were measured by immunoenzymometric assay.

Results: IFN-γ, TNF-α, and IL-2 production by T cells decreased significantly by 48.3%, 36.6%, and 36.8%, respectively, on postoperative day 1 after CCE, but not after LCE. These results indicate severe suppression of Th1-type and pro-inflammatory cytokines after the open operation. In contrast, IL-4 and IL-10 did not show significant changes in either group suggesting that Th2 cell response and anti-inflammatory activity remained normal.

Conclusions: The present study shows that open, but not laparoscopic cholecystectomy is associated with a marked suppression of T lymphocytes functions as indicated by deregulation of both the Th1/Th2 and the pro-/anti-inflammatory cytokine balance. The results therefore suggest that downregulation of Th1 cell–mediated immune response and pro-inflammatory activity of T cells is a hallmark of open, but not laparoscopic surgery.

Section snippets

Patients

In a prospective, nonrandomized study that was approved by the Technical University of Munich Ethical Committee, we analyzed the immune functions of 26 patients submitted to laparoscopic cholecystectomy (LCE) and 17 patients undergoing conventional cholecystectomy (CCE) for symptomatic cholecystolithiasis at the Surgical Department of the Technical University of Munich. Mean age for the laparoscopic group was 46.0 years (± 2.0, range 30 to 72) for 17 women and 9 men. For CCE, mean age was

Results

To evaluate the effect of minimally invasive surgery on Th1 and Th2 cell function, secretion of the cytokines IFN-γ, IL-2, and IL-4 before and after laparoscopic or open cholecystectomy was determined. In addition, TNF-α and IL-10 were measured to compare the effects of laparoscopic and open surgery on the balance of pro- and anti-inflammatory cytokines secreted by T cells. To detect functional alterations intrinsic to T cells and to exclude that the activity of antigen-presenting cells might

Comments

Among CD4+ T lymphocytes, Th1 and Th2 phenotypes may be distinguished.14 Th1 cells are mainly characterized by secretion of IFN-γ and IL-2 and induce cell-mediated immune responses. Th2 cells preferentially secrete the cytokines IL-4, IL-5, IL-6, and IL-13; and their activation favors humoral immune responses.15, 16 After major conventional surgery, our previously published results showed that IFN-γ and IL-2 secretion was reduced in the early postoperative phase, reflecting impaired function of

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    This work was supported by DFG grants Si 208/5-1 and Si 208/5-4 to the clinical research group, “Immunosuppression und Postoperative Sepsis.”

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