RESUMO
Minimally invasive surgery produced major changes in treating abdominal malignancies and early stage lung cancer. Laparoscopy and thoracoscopy are less traumatic than open surgery: allow faster recovery, shorter hospital stay, better cosmesis. Although these clinical benefits are important, prolonged disease-free interval, long-term survival with improved quality of life are most important endpoints for oncologic surgery. Major surgery causes significant alteration of immunological response, of particular importance in oncologic patients, as postoperative immunosuppression has been related to septic complications, lower survival rate, tumor spread and metastases. Clinical studies have shown laparoscopic surgery preserves better the patient's immunological function. Postoperative plasma peak concentrations of IL-6, IL-10, C-reactive protein (CRP) and TNF-alpha were lower after laparoscopic colonic resection. Prospective thoracoscopic VATS lobectomy trials found better preservation of lymphocyte T-cell function and quicker return of proliferative responses to normal, lower levels of CRP, thromboxane and prostacyclin. Immune function is influenced by the extent of surgical trauma. Minimally invasive surgery show reduced acute-phase responses compared with open procedures and better preservation of cellular immune mechanisms.
Assuntos
Biomarcadores/sangue , Laparoscopia , Neoplasias/imunologia , Neoplasias/cirurgia , Cirurgia Torácica Vídeoassistida , Neoplasias Abdominais/imunologia , Neoplasias Abdominais/cirurgia , Proteína C-Reativa/metabolismo , Colectomia/métodos , Intervalo Livre de Doença , Epoprostenol/sangue , Medicina Baseada em Evidências , Humanos , Hospedeiro Imunocomprometido , Interleucina-10/sangue , Interleucina-6/sangue , Neoplasias Pulmonares/imunologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/métodos , Cuidados Pós-Operatórios , Linfócitos T/imunologia , Tromboxanos/sangue , Fator de Necrose Tumoral alfa/sangueRESUMO
At present there is accumulating evidence supporting the D2 lymphadenectomy in gastric cancer performed according the rules of the Japanese school of surgery. The D2 lymphadenectomy by open surgery seems to gain a wide acceptance and to become a standard therapy. The minimally invasive D2 lymphadenectomy (by laparoscopic or robotic surgery) in advanced gastric cancer showed promising results. However, these advanced minimally invasive techniques have still to be performed only in highly specialized surgical centers, with a large experience in oncological surgery. Further clinical trials are needed in order to verify the encouraging data of the few studies published until now in this field.
