Changes in Immune Function

This is a controversial topic with regards to oncologic laparoscopy that is under study at this time.

Although improved systemic cell-mediated immunity after laparoscopic procedures has been documented, impairment of intraperitoneal cell-mediated immunity has been shown with pneumoperitoneum.

The mechanism of this is unknown, but in vitro studies have shown macrophages incubated in CO2 produced significantly less tumor necrosis factor and IL-1 in response to LPS compared to controls.

Others have implicated a stimulatory effect on tumors by CO2.

This combined with excessive manipulation of the tumor and difficulty in obtaining negative margins or decreased lymph node sampling has led to criticism in the use of laparoscopy for oncologic procedures.

However, clinical studies comparing open to laparoscopic colon resections have not shown an increased rate of tumor recurrence at follow-up of 5 years.

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