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Comparative evaluation of circulating cytotoxic T lymphocytes and natural killer cells after laparoscopic and open cholecystectomy

Over the past few years, it was repeatedly emphasized that open cholecystectomy (OC) owing to the greater trauma and prolonged anesthesia and recovery time is more associated with reduced immune functions than minimally invasive, laparoscopic cholecystectomy (LC), having important implications for the development of postoperative sepsis and malignant diseases. Contributing to this field, in this study we tried to evaluate particularly the role of cytotoxic subsets of circulating mononuclear lymphatic cells and modulatory mechanisms in these events. METHODS: A total of 44 patients were studied. Twenty-one of them underwent LC ; the remaining 23 were operated using the open technique. Control group consisted of 20 healthy donors. Peripheral venous blood samples were drawn 1 day before surgery and repeated on the first day after surgery. Flow cytometry was used for simultaneous detection of intracellular (perforin) and cell surface antigens on T lymphocytes (CD3+, CD4+, CD8+) and NK cells (CD16+ and CD56+ cells). The subsets of lymphocytes were then in each person correlated with serum levels of bilirubin, alkaline phosphatase (AP), aspartat (AST) and alanine (ALT) aminotransferase, gamma-glutamyl transferase (GGT), glucose, urea and creatinin, as well as with concentrations of inflammatory mediators (tumor necrosis factor-a, interleukin-6 (IL-6), C-reactive protein (CRP), polymorphonuclear leucocytes and monocytes). Statistical analysis was performed using the Mann-Whitney U test for paired samples. Linear regression equations were generated using a least-squares method and analyzed for differences of covariance. RESULTS: The data showed that both operations induce early postoperative inflammation with neutrophilia and increase of CRP and IL-6. However, OC significantly decreased the percentage of CD56+ cells and increased the percentage of CD19+ cells, while LC decreased the percentage of CD8+P+ T cells, and significantly increased the proportion of CD16+P+ and CD56+P+ NK cells. After LC, the later cells were found also to be in high positive correlation with serum concentrations of direct bilirubin, AP and GGT. After both types of operations linear regression analysis revealed also the existence of positive correlations between the intensity of cholestasis and the number of CD4+P+ cells in peripheral blood. Furthermore, the data showed that after the both types of operations the number of P+ T cells and P+ NK cells correlate not only with the number of polymorphonuclear leucocytes and CRP, but also with serum concentrations of electrolyte (Na+ and K+). Moreover, after LC the circulating P+ NK cells were in highly positive correlation, and P+ T cells in negative correlation with the level of glucose in the blood, pointing to the new regulatory mechanisms of cytotoxic cells, activated probably by the use of carbon dioxide pneumoperitoneum. CONCLUSIONS: The data implicate that LC might have a greater effect on P+ NK cells, but the findings of different metabolic and stress responses to cholestasis and operative stress, where several factors were in close interrelationship with the T and NK cells point to distinct mechanisms of immunoregulation and the complexity of interpretation in this field.

classic cholecystectomy; cytotoxic T cells and NK cells

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