Journal of Modern OncologyJournal of Modern OncologyСовременная онкология1815-14341815-1442LLC Obyedinennaya Redaktsiya26733ArticlesСтатьиResearch ArticleVliyanie endokhirurgicheskogo vmeshatel'stva na protivoopukholevuyu rezistentnost' organizmaВлияние эндохирургического вмешательства на противоопухолевую резистентность организмаSletinaS YuСлетинаС ЮKomarovI GКомаровИ ГГУ РОНЦ им. Н.Н.Блохина РАМН, Москва15062008102NO2 (2008)ТОМ 10, №2 (2008)9810609042020Copyright ©; 2008, Consilium MedicumCopyright ©; 2008, ООО "Консилиум Медикум"2008Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc/4.0https://modernonco.orscience.ru/1815-1434/article/view/26733

В последнее время все чаще в лечении онкологических больных применяют малоинвазивные методики оперирования. По сравнению с ранее выполняемыми хирургическими вмешательствами использование видеоэндоскопической хирургии позволяет уменьшить травматичность операции, ускорить реабилитацию пациентов, снизить сроки пребывания больных в стационаре. Однако постоянно возникают вопросы о сопоставимости отдаленных результатов лечения. Анализ последних данных литературы свидетельствует, что результаты лапароскопических вмешательств у онкологических больных сопоставимы с таковыми при лапаротомном доступе или превосходят их, что объясняют влиянием оперативного доступа на показатели клеточного и гуморального иммунитета.В большинстве исследований, сделанных в этом направлении, доказано, что минимально инвазивный доступ приводит к более низкому послеоперационному уровню С - реактивного белка, интерлейкина (ИЛ) 1, 6, 8, 10, меньшей супрессии лимфоцитарной активности, общего количества Т-лимфоцитов, Т-хелперов, цитотоксических Т-лимфоцитов, нормальных киллерных (NК) клеток. Однако влияние пневмоперитонеума (тип газа, уровень давления, продолжительность инсуфляции) и операционной травмы на опухолевый рост, диссеминацию и противоопухолевый иммунитет требует дальнейшего тщательного изучения.

онкологические заболеванияпротивоопухолевая резистентностьвидеоэндоскопическая хирургияAbu-Rustum N.R., Sonoda Y, Chi D.S. et al. The effects of CO2 pneumoperitoneum on the survival of women with persistent metastatic ovarian cancer. Gynecol Oncol 2003; 90: 431–4.Agostini A, Robin F, Jais P et al. Impact of different gases and pneumoperitoneum pressures on tumor growth during laparoscopy in rat model. Surg Endosc 2002; 16: 529–32.Bouvy N.D., Giuffrida M.C., Tseng L.N. et al. Effects of carbon dioxide pneumoperitoneum, air pneumoperitoneum, and gasless laparoscopy on body weight and tumor growth. Arch Surg - 1998; 133 (6): 652–6.Bouvy N.D., Marquet R.L., Jeekel H et al. Impact of gas(less) laparoscopy and laparotomy on peritoneal tumor growth and abdominal wall metastases. Ann Surg 1996; 224 (6): 694–700.Bouvy N.D., Marquet R.L., Jeekel J et al. Laparoscopic surgery is associated with less tumour growth stimulation than conventional surgery: an experimental study. Br J Surg 1997; 84 (3): 358–61.Canis M, Botchorishvilli R, Wattiez A et al. Tumor growth and dissemination after laparotomy and CO2 pneumoperitoneum: a rat ovarian cancer model. Obstet Gynecol 1998; 92: 104–8.Canis M, Farina M, Jardon K et al. Laparoscopy and gynecologic cancer in 2005. J Gynecol Obstet Biol Reprod 2006; 35 (2): 117–35.Condon E.T., Barry B.D., Wang J.H. et al. Laparoscopic surgery protects against the oncologic adverse effects of open surgery by attenuating endothelial progenitor cell mobilization. Surg Endosc 2007; 21 (1): 87–90.Condon E.T., Wang J.H., Redmond H.P. Surgical injury induces the mobilization of endothelial progenitor cells. Surgery 2004; 135 (6): 657–61.Da Costa M.L., Redmond H.P., Finnegan N et al. Laparotomy and laparoscopy differentially accelerate experimental flank tumour growth. Br J Surg 1998; 85 (10): 1439–42.Dorrance H.R., Oien K, O`Dwyer P.J. Effects of laparoscopy on intraperitoneal tumor growth and distant metastasis in an animal model. Surgery 1999; 126: 35–40.Fuganti P.E., Rodrigues A.J., Rodrigues C.J. et al. A comparison of the effects of pneumoperitoneum and laparotomy on Natural cell mediated cytotoxicity and Walker tumor growth in Wistar rats. Surg Endosc 2006; 20: 1858–61.Fujii K, Izumi K, Sonoda K et al. Less impaired cell - mediated immune response in the murine peritoneal cavity after CO(2) pneumoperitoneum. Surg Today 2003; 33 (11): 833–8.Gutt C.N., Gessmann T, Schemmer P et al. The impact of carbon dioxide and helium insufflation on experimental liver metastases, macrophages, and cell adhesion molecules. Surg Endosc 2003; 17 (10):1628–31.Gutt C.N., Kim Z.G., Schemmer P et al. Impact of laparoscopic and conventional surgery on Kupffer cells, tumor - associated CD44 expression, and intrahepatic tumor spread. Arch Surg 2002; 137 (12): 1408–12.Hazebroek E.J., Haitsma J.J., Lachmann B et al. Impact of carbon dioxide and helium insufflation on cardiorespiratory function during prolonged pneumoperitoneum in an experimental rat model. Surg Endosc 2002; 16 (7): 1073–8.Hu J.K., Zhou Z.G., Chen Z.X. et al. Comparative evaluation of immune response after laparoscopical and open total mesorectal excisions with anal sphincter preservation in patients with rect cancer. World J Gastroenterol 2003; 9 (12): 690–4.Kim S.H., Park I.J., Joh Y.G. et al. Laparoscopic resection for rectal cancer: a prospective analysis of thirty - month follow - up outcomes in 312 patients. Surg Endosc 2006; 20 (8): 1197–202.Kitano S, Shiraishi N, Uyama I et al. A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 2007; 68 (72): 245–6.Lechaux D, Redon Y, Trebuchet G et al. Laparoscopic rectal excision for cancer using total mesorectaol excision (TME). Long term outcome of a series of 179 patients. Ann Chir 2005; 139 (4): 224–34.Lee S.W., Feingold D.L., Carter J.J. et al. Peritoneal macrophage and blood monocyte functions after open and laparoscopic - assisted cecectomy in rats. 2003.Lee S.W., Scouhall J.C., Allendorf J.D. et al. Tumor proliferative index is higher in mice undergoing laparotomy vs. CO2 pneumoperitoneum. Dis Colon Rectum 1999; 42: 477–81.Lelong B, Bege T, Esterni B et al. Short - term outcome after laparoscopic or open restorative mesorectal excision for rectal cancer: a comparative cohort study. Dis Colon Rectum 2007; 50 (2): 176–83.Leng J, Lang J, Jiang Y et al. Impact of different pressures and exposure times of a simulated carbon dioxide pneumoperitoneum environment on proliferation and apoptosis of human ovarian cancer cell lines. Surg Endosc 2006; 20: 1556–9.Leung K.L., Tsang K.S., Ng M.H. et al. Lymphocyte subsets and natural killer cell cytotoxicity after laparoscopically assisted resection of rectosigmoid carcinoma. Surg Endosc 2003; 17 (8): 1305–10.Liang J.T., Huang K.C., Lai H.S. et al. Oncologic results of laparoscopic versus conventional open surgery for stage II or III left - sided colon cancers: a randomized controlled trial. Ann Surg Oncol 2007; 14 (1): 109–17.Matsumoto E.D., Margulis V, Tunc L et al. Cytokine response to surgical stress: comparison of pure laparoscopic, hand - assisted laparoscopic, and open nephrectomy. J Endourol 2005; 19 (9): 1140–5.Muntener M, Nielsen M.E., Romero F.R. et al. Long - term oncologic outcome after laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma. Eur Urol 2007; 51 (6): 1639–44.Nakamura T, Mitomi H, Ohtani Y et al. Comparison of long - term outcome of laparoscopic and conventional surgery for advanced colon and rectosigmoid cancer. Hepatogastroenterology 2006; 53 (69): 351–3.Neuhaus S.J., Ellis T.S., Barrett M.W. et al. In vitro inhibition of tumor grouth in a heliumrich environment: implication for laparoscopic surgery. Aust N Z J Surg 1999; 69: 52–5.Nickkholgh A, Barro-Bejarano M, Liang R et al. Signs of reperfusion injury following CO(2) pneumoperitoneum: an in vivo microscopy study. Surg Endosc 2007; 21 (1): 80–3.Pauwels M, Lauwers P, Hendrincs J et al. The effects of CO2 pneumoperitoneum on the tumor grouth of a solid colon carcinoma in rats. Surg Endosc 1999; 13: 998–1000.Pera M, Nelson H, Rajkumar S.V. et al. Influence of postoperative acutephase response on angiogenesis and tumor growth: open vs. laparoscopic - assisted surgery in mice. J Gastrointest Surg 2003; 7 (6): 783–90.Rabson A, Roitt I, Delves P et al. Really essential medical immunology. Blackwell Publishing 2005; p. 320.Sample C.B., Watson M, Okrainec A et al. Long - term outcomes of laparoscopic surgery for colorectal cancer. Surg Endosc 2006; 20 (1): 30–4.Sandoval B.A., Sulaiman T.T., Robinson A.V. et al. Laparoscopic surgery in a small animal model. A simplified technique of retroperitoneal dissection in the rat. Surg Endosc 1996; 10 (9): 925–7.Sietses C, Havenith C.E., Eijsbouts Q.A. et al. Laparoscopic surgery preserves monocyte - mediated tumor cell killing in contrast to the conventional approach. Surg Endosc 2000; 14 (5): 456–60.Smidt V, Singh D.M., Hurteau J.A. et al. Effect of carbon dioxide on human ovarian carcinoma cell growth. Am J Obstet Gynecol 2001; 185: 1314–7.Svendsen M.N., Werther K, Christensen I.J. et al. Influence of open versus laparoscopically assisted colectomy on soluble vascular endothelial growth factor (sVEGF) and its soluble receptor 1 (sVEGFR1). Inflamm Res 2005; 54 (11): 458–63.Takeuchi I, Ishida H, Mori T et al. Comparison of the effects of gasless procedure, CO2-pneumoperitoneum, and laparotomy on splenic and hepatic natural killer activity in a rat model. Surg Endosc 2004;18 (2): 255–60.Tang C.L., Eu K.W., Tai B.C. et al. Randomized clinical trial of the effect of open versus laparoscopically assisted colectomy on systemic immunity in patients with colorectal cancer. Br J Surg 2001; 88 (6): 801–7.West M.A., Hackam D.J., Baker J et al. Mechanism of decreased in vitro murine macrophage cytokine release after exposure to carbon dioxide: relevance to laparoscopic surgery. Ann Surg 1997; 226 (2): 179–90.Wichmann M.W., Huttl T.P., Winter H et al. Immunological effects of laparoscopic vs open colorectal surgery: a prospective clinical study. Arch Surg 2005; 140 (7): 692–7.Wittich P, Mearadji A, Marquet R.L. et al. Increased tumor growth after high pressure pneumoperitoneum with helium and air. J Laparoendosc Adv Surg Tech A 2004; 14 (4): 205–8.Yokoyama M, Ishida H, Okita T et al. Oncological effects of insufflation with different gases and a gasless procedure in rats. Surg Endosc 2003; 17 (7): 1151–5.