Retrospective Cohort Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2484-2493
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2484
Impact of minimally invasive surgery on immune function and stress response in gastric cancer patients
Rong-Hua Zhu, Peng-Cheng Li, Jie Zhang, Hua-Hua Song
Rong-Hua Zhu, Peng-Cheng Li, Jie Zhang, Department of General Surgery, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai 202150, China
Hua-Hua Song, Department of Respiratory Medicine, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Science, Shanghai 202150, China
Co-corresponding authors: Jie Zhang and Hua-Hua Song.
Author contributions: Zhang J performed conceptualization and supervision; Zhu RH and Li PC performed the investigation and wrote the original draft; Song HH reviewed and edited the manuscript.
Supported by Shanghai Chongming District Sustainable Development Science and Technology Innovation Action Plan, No. CKY2020-11.
Institutional review board statement: The ethics committee of Chongming Hospital Affiliated to Shanghai Health Medical College approved this study (approval No. IRB2020-11).
Informed consent statement: Informed consent was obtained from all patients.
Conflict-of-interest statement: The authors declare that they have no competing interests to disclose.
Data sharing statement: All data generated or analyzed during the present study are included in this published article.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement- checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hua-Hua Song, PhD, Doctor, Department of General Surgery, Chongming Hospital Affiliated to Shanghai University of Medicine and Health Sciences, No. 25 Nanmen Road, Chongming, District, Shanghai 202150, China. gmail.med@foxmail.com
Received: March 12, 2024
Revised: May 17, 2024
Accepted: June 6, 2024
Published online: August 27, 2024
Processing time: 157 Days and 1.6 Hours
Abstract
BACKGROUND

Gastric cancer remains a leading cause of cancer-related mortality globally. Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.

AIM

To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer, focusing on its potential to reduce trauma, accelerate recovery, and achieve comparable oncological outcomes.

METHODS

This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023. The patients were divided into two groups: Minimally invasive surgery group (n = 102), who underwent laparoscopic gastrectomy, and open surgery group (n = 101), who underwent traditional open gastrectomy. We compared surgical indicators (surgical incision size, intraoperative blood loss, surgical duration, and number of lymph nodes dissected), recovery parameters (time to first flatus, time to start eating, time to ambulation, and length of hospital stay), immune function (levels of IgA, IgG, and IgM), intestinal barrier function (levels of D-lactic acid and diamine oxidase), and stress response (levels of C-reactive protein, interleukin-6, and procalcitonin).

RESULTS

The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators, including smaller incisions, less blood loss, shorter surgery time, and more lymph nodes dissected (P < 0.05 for all). Recovery was also faster in the minimally invasive surgery group, with earlier return of bowel function, earlier initiation of diet, quicker mobilization, and shorter hospital stays (P < 0.05 for all). Furthermore, patients in the minimally invasive surgery group had better preserved immune function, superior intestinal barrier function, and a less pronounced stress response postoperatively (P < 0.05 for all).

CONCLUSION

Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function, protecting intestinal barrier function, and mitigating the stress response compared to traditional open surgery. These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.

Keywords: Gastric cancer; Laparoscopic surgery; Minimally invasive surgery; Immune function; Intestinal barrier; Stress response

Core Tip: This study delineates the comparative efficacy of laparoscopic vs traditional open gastrectomy for gastric cancer, elucidating laparoscopy's superiority in surgical outcomes, expedited patient recovery, and enhanced preservation of postoperative immune and intestinal functions, thereby advocating for its broader implementation in clinical practice.