Systemic Immunologic and Inflammatory Response After Laparoscopic Versus Open Nephrectomy: A Prospective Cohort Trial

Purpose: To compare the dynamics of systemic inflammatory indices during laparoscopic nephrectomy (LN) and standard open donor nephrectomy. Patients and Methods: Participants in this cohort study were 54 adults without a history of renal surgery and no evidence of urinary tract infection who underwent transperitoneal LN (n = 29) and open donor nephrectomy (n = 25, control group). We recorded demographic characteristics, intraoperative parameters, and changes 24 hours postoperatively in systemic inflammatory and immunologic values (body temperature, concentrations of white blood cell count [WBC], C-reactive protein [CRP], interleukin [IL]-6, and tumor necrosis factor [TNF]-alpha), and compared the mean changes between groups. Results: Mean age was older in the LN group (45.6 vs 30.9 years; P < 0.0001), and mean operative time was significantly shorter (83.1 min vs 101.6 min; P = 0.004). Mean postoperative increase in IL-6 and body temperature in LN was significantly less than in control: For IL-6, 15.87 vs 29.09 pg/mL, P = 0.03; for body temperature, +0.22 degrees C vs +0.71 degrees C, P = 0.001). Mean postoperative increases in levels of other inflammatory markers (CRP, TNF-alpha, WBC) did not differ significantly. No statistical correlation was found between operative time and changes in IL-6, CRP, TNF-alpha, WBC, or body temperature. Conclusion: Based on the smaller increase in serum IL-6 as the most important indicator of surgical stress, the surgical trauma-induced immune dysfunction may be less intense after LN than open surgery. This may explain the smooth convalescence after LN.