Journal of Gastric Cancer

The Korean Gastric Cancer Association (대한위암학회)
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Comparison of the Nutritional Status and the Acute Inflammatory Reaction between Laparoscopy-assisted Distal Gastrectomy and Conventional Open Distal Gastrectomy for Early Gastric Cancer

조기위암에서 복강경 및 개복 위아전절제술에 따른 영양학적 및 면역염증반응의 비교

  • Chae, Hyun-Dong (Department of Surgery, School of Medicine, Daegu Catholic University)
  • 채현동 (대구가톨릭대학교 의과대학 외과학교실)
  • Received : 2010.02.25
  • Accepted : 2010.03.31
  • Published : 2010.03.30
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Abstract

Purpose: Laparoscopy-assisted gastrectomy (LAG) is gaining wider acceptance as a minimally invasive treatment for early gastric cancer, but the safety, efficacy and clinical benefits of this type of surgery are still unclear. The purpose of this study is to compare laparoscopy-assisted gastrectomy (LADG) and conventional open distal gastrectomy (CODG) for early gastric cancer (EGC) according to the changes of the postoperative nutritional status and acute inflammatory reaction. Materials and Methods: Eighty seven patients with EGC and who underwent a LADG between March 2006 and May 2009 at Daegu Catholic University Hospital, was enrolled. Over the same period, we enrolled 30 patients who underwent CODG and they were confirmed to have EGC from their pathology. The clinico-pathological features and serologic parameters were evaluated from the medical records and then retrospectively analyzed. Results: There were no differences in the preoperative white blood cell (WBC), C-reactive protein (CRP) level, albumin level, the T4/T8 ratio and the other clinical data between the two groups. The total WBC counts gradually increased and they were significant lower at the $1^{st}$ and $3^{rd}$ postoperative days in the LADG group than that in the CODG group (P=0.001 and 0.008, respectively). The postoperative CRP levels were significantly lower at postoperative $5^{th}$ day in the LADG group (P<0.001). The postoperative albumin and T4/T8 ratio gradually decreased, and the T4/T8 ratio was significantly higher at the $3^{rd}$ postoperative day in the LADG group compared to that in the CODG group (P=0.003). Conclusion: This study demonstrates that the LADG has less of an influence on an acute inflammatory reaction than does CODG. Therefore, it is one of the safe and feasible procedures for the treatment of early gastric cancer.

목적: 복강경하 보조 위 절제술이 위암 치료에 사용되기 위해서는 기술적인 측면 외에 수술적 치료와 관계하는 영양학적 및 면역학적 요소가 함께 고려되어야 한다. 이에 본 연구에서는 조기위암 환자에서 복강경하 위아전절제술의 영양학적 및 면역학적 측면에서의 안정성에 대해 알아 보고자 본 연구를 시행하였다. 대상 및 방법: 2006년 4월부터 2009년 5월까지 조기위암으로 복강경하 위아전절제술을 시행한 87예와 개복 위아전절제술을 시행한 30명의 환자를 대상으로 임상 정보와 혈청학적 검사를 후향적으로 비교 분석하였다. 결과: 두 군 간의 술 전 임상병리학적 요인에는 차이가 없었으며, 복강경하 위아전절제술군에서 총 백혈구수는 개복군에 비해 술 후 1일째와 3일째 더 증가 정도가 낮았으며(P=0.001, P=0.008), CRP는 술 후 1일째와 3일째에서 증가 정도의 차이를 보이지 않았으나(P=0.632, P=0.139), 술 후 5일째의 감소 정도는 통계학적 차이를 보였다(P<0.001). T4/T8 ratio는 복강경하 위아전절제술군에서 술 후 3일째 감소 정도가 적었으나(P=0.003), Albumin의 감소 정도는 통계학적 차이를 보이지 않았다(P=0.157). 결론: 복강경 위아전절제술은 개복 위절제술에 비해 Albumin을 이용해 비교한 영양학적 측면에서 장점은 없었으나, 술 후 총 백혈수의 증가, CRP 감소, 및 T4/T8 ratio 감소 등의 전신 면역 및 염증 반응에서 우월함을 알 수 있었다.

Keywords

References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopyassisted Billroth I gastrectomy. Surg Laparosc Endosc 1994; 4:146-148.
  2. Kim HH, Kim KH, Kim DH, Kim MC, Kim BS, Kim YW, Kim YI, Kim YH, Kim W, Kim WW, et al. Nationwide survey of laparoscopic gastric surgery in Korea, 2004. J Korean Gastric Cancer Assoc 2005;5:295-303.
  3. Kitano S, Shimoda K, Miyahara M, Shiraishi N, Bandoh T, Yoshida T, Shuto K, Kobayachi M. Laparoscopic approaches in the management of patients with early gastric carcinomas. Surg Laparosc Endosc 1995;5:359-362.
  4. Tanimura S, Higashino M, Fukunaga Y, Osugi H. Laparoscopic gastrectomy with regional lymph node dissection for upper gastric cancer. Gastric Cancer 2003;6:64-68. https://doi.org/10.1007/s101200300009
  5. Kim HH. Laparoscopic Billroth II gastrectomy for benign gastric disease. J Korean Soc Endosc & Laparosc Surg 1999; 2:11-18.
  6. Cho GS, Kim HC, Lee MS, Lim CW, Shin EJ, Chu CW, Kang KH, Kim YJ, Yu KW, Lee HW, et al. A prospective study comparing of laparoscopy-assisted vs conventional open gastrectomy for gastric cancer. J Korean Surg Soc 2006;70: 175-181.
  7. Nakajima T. Gastric cancer treatment guideline in Japan. Gastric Cancer 2002;5:1-5.
  8. Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND. Stress response to laparoscopic surgery: a review. Surg Endosc 2004;18:1022-1028.
  9. Kuhry E, Jeekel J, Bonjer HJ. Effect of laparoscopy on the immune system. Semin Laparosc Surg 2004;11:37-44.
  10. Landman J, Olweny E, Sundaram CP, Chen C, Rehman J, Lee DI, Shalhay A, Portis A, McDougall EM, Clayman RV. Prospective comparison of the immunological and stress response following laparoscopic and open surgery for localized renal cell carcinoma. J Urol 2004;171:1456-1460. https://doi.org/10.1097/01.ju.0000118649.56016.1c
  11. Dunker MS, Ten Hove T, Bemelman WA, Slors JF, Gouma DJ, Van Deventer SJ. Interleukin-6, C-reactive protein, and expression of human leukocyte antigen-DR, on peripheral blood mononuclear cells in patients after laparoscopic vs. conventional bowel resection: a randomized study. Dis Colon Rectum 2003;46:1238-1244. https://doi.org/10.1007/s10350-004-6721-z
  12. Hu JK, Zhou ZG, Chen ZX, Wang LL, Yu YY, Liu J, Zhang B, Li L, Shu Y, Chen JP. Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rectal cancer. World J Gastroenetrol 2003;9:2690-2694. https://doi.org/10.3748/wjg.v9.i12.2690
  13. Gupta A, Watson DI. Effect of laparoscopy on immune function. Br J Surg 2001;88:1296-1306. https://doi.org/10.1046/j.0007-1323.2001.01860.x
  14. Allendorf JD, Bessler M, Whelan RL, Trokel M, Laird DA, Terry MB, Treat MR. Better preservation of immune function after laparoscopic-assisted vs. open bowel resection in a murine model. Dis Colon Rectum 1996;39(10 Suppl):67S-72S. https://doi.org/10.1007/BF02053809
  15. Kang TY, Kim MC, Kwon HC, Kim KH, Kim HH, Jung GJ. Comparison of cell-mediated immune response after laparoscopic vs open gastrectomy in gastric cancer. J Korean Surg Soc 2005;69:36-41.
  16. Steel DM, Whitehead AS. The major acute phase reactants: C-reactive protein,serum amyoid P component and serum amyloid A protein. Immunol Today 1994;15:81-88. https://doi.org/10.1016/0167-5699(94)90138-4
  17. Malle E, De Beer FC. Human serum amyloid A (SAA) protein: a prominent acute-phase reactant for clinical practice. Eur J Clin Invest 1996;26:427-435. https://doi.org/10.1046/j.1365-2362.1996.159291.x
  18. Rey-Ferro M, Castaño R, Orozco O, Serna A, Moreno A. Nutritional and immunologic evaluation of patients with gastric cancer before and after surgery. Nutrition 1997;13:878-881. https://doi.org/10.1016/S0899-9007(97)00269-4
  19. Watson RW, Redmond HP, McCarththy J, Burke PE, Bouchier- Hayes D. Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model. Br J Surg 1995;82:1060-1065. https://doi.org/10.1002/bjs.1800820820
  20. Neuhaus SJ, Watons DI, Ellis T, Rofe AM, Jamieson GG. The effect of immune enhancement and suppression on the development of laparoscopic port site metastasis. Surg Endosc 2000;14:439-443. https://doi.org/10.1007/s004640000157
  21. Kyle UG, Schneider SM, Pirlich M, Lochs H, Hebuterne X, Pichard C. Does nutritional risk, as assessed by nutritional risk index, increase during hospital stay? A multinational population- based study. Clin Nutr 2005;24:516-524. https://doi.org/10.1016/j.clnu.2005.04.003