A Comparison of Cellular Immune Response and Immunological Biomarkers in Laparoscopic Surgery for Colorectal Cancer and Benign Disorders

• Published in: Clinical colorectal cancer 2024-12, Vol.23 (4), p.372-381.e1
• Main Authors: Nederby, Line, Trabjerg, Natacha Dencker, Andersen, Anja Bjørnskov, Lindebjerg, Jan, Hansen, Torben Frøstrup, Rahr, Hans Bjarke
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; B7-H1 Antigen - blood; Biomarkers - blood; Colorectal cancer; Colorectal Neoplasms - blood; Colorectal Neoplasms - immunology; Colorectal Neoplasms - surgery; Female; Humans; Immunity, Cellular; Immunosuppression; Interferon-gamma - blood; Killer Cells, Natural - immunology; Laparoscopy; Laparoscopy - methods; Male; Middle Aged; NK cell activity; Prospective Studies; Ventral hernia
• ISSN: 1533-0028; 1938-0674; 1938-0674
• DOI: 10.1016/j.clcc.2024.05.012

Surgical trauma causes immune impairment, but it is largely unknown whether surgery for cancer and benign diseases instigate comparable levels of immune inhibition. Here, we compared the impact of laparoscopic surgery on immunological biomarkers in patients with colorectal cancer (CRC) and ventral hernia (VH). Natural Killer cell activity (NKA), leukocyte subsets, and soluble programmed death ligand 1 (sPD-L1) were measured in blood samples collected from CRC (n = 29) and VH (n = 9) patients preoperatively (PREOP) and on postoperative day (POD) 1, 3-6, 2 weeks and 3 months. NKA was evaluated by the NK Vue assay that uses the level of IFNγ as a surrogate marker of NKA. Normal NKA was defined as IFNγ > 250 pg/mL and low NKA was defined as IFNγ < 250 pg/mL. The CRC cohort was classified into either PREOPLOW having preoperative low NKA or PREOPHIGH having preoperative normal NKA. The median NKA of the PREOPLOW subset was only in the normal range in the POD3 months sample, whereas median NKA of the PREOPHIGH subset and the VH cohort were only low in the POD1 sample. While PREOPLOW differed from VH in the PREOP-, POD1-, and POD3-6 samples (P =.0006, P = .0181, and P = .0021), NKA in PREOPHIGH and VH differed in the POD1 samples (P = .0226). There were no apparent differences in the distribution of leukocyte subsets in the perioperative period between the cohorts. CRC patients with preoperative normal NKA and VH patients showed the same pattern of recovery in NKA, while the CRC subset with preoperative low NKA seemed to experience prolonged NK cell impairment. As low NKA is associated with recurrence, preoperative level of NKA may identify patients who will benefit from immune-enhancing therapy in the perioperative period. The study explored the immunosuppressive effect of surgery. Colorectal cancer (CRC) patients with preoperative normal Natural Killer cell activity (NKA) and ventral hernia patients showed the same pattern of NKA recovery, while CRC patients with preoperative low NKA seemed to experience prolonged NKA impairment. Low preoperative NKA may identify patients who will benefit from perioperative immunostimulatory therapy.