[Correlation of the frequency of surgical procedures on the peripheral immunologic organs with the frequency of oncologic and other somatic diseases].

Regional Oncological Dispensary, Kostroma The study included 388 cancer patients (group 1) and 381 cases of other pathologies (group 2). Surgery on lymphoid organs was performed in 121 patients (31%) in group 1 and 150 in group 2. It was concluded that such intervention in the immune system was not an oncological hazard. That phenomenon might be accounted for by the specificity of immune response in patients suffering from such diseases.

Mini-invasive surgery may be advised in oncology.

In the last decade mini-invasive surgery has consistently developed with good results, but also with some unjustified clinical applications. This review is aimed at defining evidence based indications and procedures ('clinical practice') and those still worthy of controlled studies in oncologic centers with expertise in mininvasive surgery ('clinical research'). At present, diagnostic and staging laparoscopy and thoracoscopy represent the 'standard' for different tumors. Conversely, therapeutic indications according to evidence based medicine criteria are still limited. Tumors treatment by mini-invasive surgery requires 'expertise' on the part of the surgical team; this can be achieved by extensive training of a correct use of instruments and methods following the general surgical principles of traditional 'open surgery'.

Effect of surgical stress on immune function in patients with urologic cancer.

BACKGROUND: To determine the immunosuppressive effect of surgery for urologic cancers, multiple variables of immune function were measured serially before and after operation in patients with urologic cancer. METHODS: Peripheral blood was obtained before operation and at postoperative day 7 and 14 from 20 patients with bladder cancer, renal pelvic, or ureteral cancer, or renal cell carcinoma. RESULTS: In patients with bladder cancer who were undergoing radical cystectomy with use of intestine for urinary diversion, the serum level of immunosuppressive acidic protein (IAP) increased, and serum levels of immunoglobulin (Ig)A, IgG, and IgM decreased after operation. In contrast, the number of CD25+ lymphocytes significantly increased. Transurethral resection of bladder cancer also resulted in an increase in serum IAP level, however, the number of CD4+ and human leukocyte-associated HLA-DR+ lymphocytes increased. In patients with renal pelvic or ureteral cancer undergoing nephroureterectomy with cuff, the level of serum IAP increased and serum IgG level decreased after operation. By contrast, the number of CD3+ lymphocytes increased. In patients with renal cell carcinoma, radical nephrectomy led to a significant increase in the number of CD8+ lymphocytes. CONCLUSIONS: These findings suggest that surgical stress in patients with urologic cancer may result in both suppression and stimulation of host immunity.

Transfusión sanguínea perioperatoria en el paciente neoplásico. I. Alteraciones inmunológicas y consecuencias clínicas / Perioperative blood transfusion inthe neoplastic patient. I. Immunological alterations and clinical consequences

La administración perioperatoria de hemoderivados alogénicos (TSA) es relativamente frecuente en los pacientes oncológicos sometidos a cirugía y, aunque nunca antes habían sido tan seguros como en la actualidad, sobre todo con respecto a la transmisión de enfermedades infecciosas, sabemos que esta práctica no está exenta de efectos adversos. Uno de ellos es la inmunomodulación inducida por transfusiones alogénicas (IMITA), que mediante mecanismos no completamente esclarecidos induce un predominio de la respuesta Th2, caracterizada por la liberación de interleucina-4 (IL-4), IL-5, IL-6, IL-10 e IL13 que inducen un predominio de la inmunidad humoral y una disminución o anulación de la inmunidad celular, creando un estado de susceptibilidad a la enfermedad. Tampoco se conocen con exactitud los componentes de la TSA que participan en la inducción de IMITA, aunque diversos estudios han implicado a los leucocitos del donante o los productos liberados por los mismos durante la conservación. En el paciente neoplásico sometido a cirugía, el grado de IMITA parece depender del volumen transfundido y va a potenciar otras alteraciones del sistema inmunitario producidas por la enfermedad de base, el estado nutricional e inflamatorio del paciente, el tipo de anestesia que se emplee, la magnitud del trauma quirúrgico y la medicación perioperatoria. Este estado de inmunodepresión, junto con las alteraciones de la microcirculación y la hipoxia tisular regional provocadas por la lesión de almacenamiento de los eritrocitos, puede llevar a un aumento de las infecciones postoperatorias y de la recurrencia del tumor, aumentando por tanto la morbimortalidad de estos pacientes. Por ello, es necesario el desarrollo de programas multidisciplinarios para optimizar el manejo transfusional del paciente oncológico y reducir el número de TSA al mínimo indispensable, disminuyendo los riesgos inherentes a las mismas (AU)