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Surgery‐induced immunomodulation and the importance of the perioperative period
Author(s) -
Boomsma Martijn F.,
Garssen Bert,
Beelen Robert H.J.
Publication year - 2010
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21772
Subject(s) - medicine , citation , perioperative , library science , surgery , computer science
Recently, we have reported our finding in this Journal that breast cancer surgery produces substantial immunomodulation as indicated by decreased HLA-DR expression, decreased NKCA, and a proinflammatory response [1]. Chen et al. [2] agreed with our overallconclusion in their comment, but brought forward some questions. It is the purpose of our reaction to underline once more the importance of surgery-induced immunomodulation and to advance some remarks on how to subdue this response and why the focus is mainly on innate immunity. In 1999, we have demonstrated that conventional fundoplication results in an activation of the systemic immune response and in immunosuppression [3], which was weaker in a laparoscopic approach. We have later shown that in colorectal carcinoma surgical trauma is directly related to peritoneal cancer recurrence [4]. Moreover, we have demonstrated in a pilot study that low doses of perioperative immunomodulation could partly counteract this immunosuppression [5]. Recently, we have put forward the thesis that the perioperative period is an underutilized window of therapeutic opportunity in patients with colorectal cancer [6]. We also showed that we could prevent surgery-induced liver metastasis through antibody therapy, which was mediated by the innate immune network [7]. This result is in agreement with the findings of other researchers working in this field [8]. According to the opinion of Chen et al. a measurement of Th1 and