Effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma

Abstract

Objective To explore the effect of retroperitoneal laparoscopic operation on immune function and neuroendocrine function in patients with renal cell carcinoma,and to evaluate clinical efficacy of retroperitoneal laparoscopic operation in treatment of renal cell carcinoma.Methods The clinical data of 36 patients subject to laparoscopic radical nephrectomy (LRN) and 27 patients with open radical nephrectomy (ORN) for renal cell carcinoma in our department from January 2010 to January 2013 were analyzed retrospectively.The renal cell carcinoma was diagnosed by preoperative ultra-sound,CT or MRI,and postoperative pathological examination.The clinical stage was T1-T2,and N0M0 in all patients.The diameter of tumors ranged 2.3-9.8 cm (5.6 cm on average),and tumor was solitary.The efficacy was evaluated by the duration of operative time,blood loss during operation and postoperative hospital stay between two groups.The changes of immune function (CD3+,CD4+,CD8+,CD4+/CD8+) and neuroendocrine function [β-endorphin,Adrenocorticotrophin (ACTH),cortisol] in patients with renal cell carcinoma before and after surgical operation were examined.Results The 63 patients were operated successfully,and there were no severe perioperative complications.Blood loss during operation was (95.0 ± 29.5) ml in LRN group and (112.8 ±31.3) ml in ORN group (P ＜0.05).The mean postoperative hospital stay was (7.1 ± 1.3) days in LRN group and (8.7 ± 1.7) days in ORN group (P＜0.05).No significant difference in operative time was noted between two groups (P ＞ 0.05).After surgical operation,the proportion of CD3 +,CD4+ and CD4 +/CD8 + in LRN group was significantly higher than in ORN group (P ＜0.05),and the levels of β-endorphin,ACTH and cortisol in LRN group were significantly lower than those in control group (P ＜0.05).Average postoperative follow-up duration was 14 months (range 3-33) in 61 patients.Imaging examinations showed no recurrence or metastasis in all patients,and no patients had longterm complication.Conclusion Retroperitoneal laparoscopic operation has advantages of clearer vision,less trauma,less blood loss,faster postoperative recovery,and shorter hospital stay.In the treatment of localized renal cell carcinoma,LRN has more advantages than ORN because LRN can protect immune function better and reduce stress response better. Key words: Renal cell carcinoma ; Laparoscopic operation ; Radical nephrectomy ; Immune function