BACKGROUND: Major abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins. PATIENTS AND METHODS: Patients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT). Serum levels of alarmins (S100A8, S100A12, HMGB1, and HSP70) and biomarkers (leukocytes, C-reactive protein [CRP], and interleukin-6 [IL-6]) were analyzed between the groups. The secondary objectives were to compare LPT and LPS cancer subgroups and to find the relationship between procedure and outcome (intensive care unit length of stay [ICU-LOS] and hospital length of stay [H-LOS]). RESULTS: A total of 82 patients were analyzed. No significant difference was found in alarmin levels between the mixed LPS and LPT groups. IL-6 was higher in the LPS group on day 2 (p=0.03) and day 3 (p=0.04). Significantly higher S100A8 protein levels on day 1 (p=0.02) and day 2 (p=0.01) and higher S100A12 protein levels on day 2 (p=0.03) were obtained in the LPS cancer subgroup. ICU-LOS and H-LOS were longer in the LPS cancer subgroup. CONCLUSION: The degree of surgical injury elicited by open MAS as reflected by alarmins is similar to that of laparoscopic procedures. Nevertheless, an early biomarker of inflammation (IL-6) was higher in the laparoscopy group, suggesting a greater inflammatory response. Moreover, the levels of S100A8 and S100A12 were higher with a longer ICU-LOS and H-LOS in the LPS cancer subgroup.

Department of Anesthesiology and Intensive Care Medicine University Hospital Ostrava Ostrava Czech Republic

Institute for Research and Applications of Fuzzy Modeling Centre of Excellence IT4Innovations University of Ostrava Ostrava Czech Republic

The Clinic of Surgery University Hospital Ostrava Ostrava Czech Republic

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Jakobson T, Karjagin J, Vipp L, et al. Postoperative complications and mortality after major gastrointestinal surgery. Medicina (Kaunas) 2014;50(2):111–117. PubMed

Weigand K, Brost S, Steinebrunner N, Büchler M, Schemmer P, Müller M. Ischemia/reperfusion injury in liver surgery and transplantation: pathophysiology. HPB Surg. 2012;2012:176723. PubMed PMC

Marik PE, Flemmer M. The immune response to surgery and trauma: implications for treatment. J Trauma Acute Care Surg. 2012;73(4):801–808. PubMed

NeSmith EG, Weinrich SP, Andrews JO, Medeiros RS, Hawkins ML, Weinrich M. Systemic inflammatory response syndrome score and race as predictors of length of stay in the intensive care unit. Am J Crit Care. 2009;18(4):339–346. PubMed

Eriksson LI, Kramer JH, Leung JM, et al. Perioperative cognitive decline in the aging population. Mayo Clin Proc. 2011;86(9):885–893. PubMed PMC

Lamm G, Auer J, Weber T, Berent R, Ng C, Eber B. Postoperative white blood cell count predicts atrial fibrillation after cardiac surgery. J Cardiothorac Vasc Anesth. 2006;20(1):51–56. PubMed

Nuremberg GH, Care I, Nuremberg GH, et al. C-reactive protein and the acute phase reaction in geriatric patients. Z Gerontol Geriatr. 2015;48(7):595–600. PubMed

Okeny PK, Ongom P, Kituuka O. Serum interleukin-6 level as an early marker of injury severity in trauma patients in an urban low-income setting: a cross-sectional study. BMC Emerg Med. 2015;15:1–7. PubMed PMC

Jain S, Gautam V, Naseem S. Acute-phase proteins: as diagnostic tool. J Pharm Bioallied Sci. 2011;3(1):118–127. PubMed PMC

Tanaka T, Narazaki M, Kishimoto T. IL-6 in inflammation, immunity, and disease. Cold Spring Harb Perspect Biol. 2014;6(10):a016295. PubMed PMC

Bianchi ME. DAMPs, PAMPs and alarmins: all we need to know about danger. J Leukoc Biol. 2007;81(1):1–5. PubMed

Somers Joann., MD High Quality Obstetrical & Gynecological Care, 2011–2015 [webpage on the Internet] [Accessed December 27, 2017]. Available from: http://www.joann-somersmd.com/health/surgeries.php.

Huang C, Shen J, Zhang J, et al. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: a retrospective case-control study. World J Gastroenterol. 2015;21:13532–13541. PubMed PMC

Davies SJ, Francis J, Dilley J, et al. Measuring outcomes after major abdominal surgery during hospitalization: reliability and validity of the Postoperative Morbidity Survey. Perioper Med (London) 2013;2(1):1. PubMed PMC

Czech Society of Intensive Care Medicine guidelines, 2014 [webpage on the Internet] [Accessed December 10, 2017]. Available from: http://www.csim.cz/dokumenty/#categories:path=doporucene-postupy.

Society of Critical Care Medicine Guidelines 2016 [webpage on the Internet] [Accessed December 10, 2017]. Available from: http://www.sccm.org/Research/Guidelines/Pages/Guidelines.aspx.

Bone R, Balk R, Cerra F, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–1655. PubMed

Foell D, Wittkowski H, Vogl T, Roth J. S100 proteins expressed in phagocytes: a novel group of damage-associated molecular pattern molecules. J Leukoc Biol. 2007;81(1):28–37. PubMed

Lotze M, Tracey K. High-mobility group box 1 protein (HMGB1): nuclear weapon in the immune arsenal. Nat Rev Immunol. 2005;5(4):331–342. PubMed

Hartl F, Hayer-Hartl M. Molecular chaperones in the cytosol: from nascent chain to folded protein. Science. 2002;295(5561):1852–1858. PubMed

Heizmann CW, Fritz G, Schäfer BW. S100 proteins: structure, functions and pathology. Front Biosci. 2002;7:d1356–d1368. PubMed

Tsan M-F, Gao B. Heat shock proteins and immune system. J Leukoc Biol. 2009;85(6):905–910. PubMed

Maca J, Holub M, Bursa F, et al. Alarmins as biomarkers of gastrointestinal surgical injury – a pilot study. APMIS. 2018;126(2):152–159. PubMed

Ramanathan ML, MacKay G, Platt J, Horgan PG, McMillan DC. The impact of open versus laparoscopic resection for colon cancer on C-reactive protein concentrations as a predictor of postoperative infective complications. Ann Surg Oncol. 2015;22(3):938–943. PubMed

Deirmengian GK, Zmistowski B, Jacovides C, O’Neil J, Parvizi J. Leukocytosis is common after total hip and knee arthroplasty. Clin Orthop Relat Res. 2011;469(11):3031–3036. PubMed PMC

Conzo G, Tartaglia E, Gambardella C, et al. Minimally invasive approach for adrenal lesions: systematic review of laparoscopic versus retroperitoneoscopic adrenalectomy and assessment of risk factors for complications. Int J Surg. 2016;28(Suppl 1):S118–S123. PubMed

Conzo G, Pasquali D, Gambardella C, et al. Long-term outcomes of laparoscopic adrenalectomy for Cushing disease. Int J Surg. 2014;12(Suppl 1):S107–S111. PubMed

Chen H, Xu C, Jin Q, Liu Z. S100 protein family in human cancer. Am J Cancer Res. 2014;4(2):89–115. PubMed PMC

Barbaros U, Asoglu O, Seven R, et al. The comparison of laparoscopic and open ventral hernia repairs: a prospective randomized study. Hernia. 2007;11(11):51–56. PubMed

Castro PM, Rabelato JT, Monteiro GG, del Guerra GC, Mazzurana M, Alvarez GA. Laparoscopy versus laparotomy in the repair of ventral hernias: systematic review and meta-analysis. Arg Gastroenterol. 2014;51(3):205–211. PubMed

Fretland A, Sokolov A, Postriganova N, et al. Inflammatory response after laparoscopic versus open resection of colorectal liver metastases. Data from the Oslo-CoMet Trial. Med (Baltimore) 2015;94(42):e1786. PubMed PMC

Zhuang CL, Huang DD, Chen FF, et al. Laparoscopic versus open colorectal surgery within enhanced recovery after surgery programs: a systematic review and meta-analysis of randomized controlled trials. Surg Endosc. 2015;29(9):2091–2100. PubMed

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