■ Most clinical and experimental studies support the view that laparoscopic surgery is associated with better preservation of postoperative systemic immune function than conventional surgery. Extrapolation of such data, however, requires further elucidation.

■ Major surgery results in a period of cell-mediated immunosuppression, which can affect the patient's recovery.

■ Open surgery is associated with higher levels of C-reactive protein and IL-6 than laparoscopy.

■ Delayed-type hypersensitivity studies indicate that open methods lead to significantly more immunosuppression than laparoscopy. This difference becomes less obvious after prolonged major laparoscopic procedures and it is possible that longer anesthetic times may have an impact on the immune response.

■ There is evidence of a short-lived greater shift towards Th2 function mainly through suppression of the Th1 lymphocytes after open surgery than after laparoscopy (90).

■ Laparoscopy also leads to lesser decreases in HLA-DR expression and monocyte-mediated cytotoxicity than its open counterpart.

■ Intraperitoneal immunity behaves independently of systemic immune function. The systemic benefits of laparoscopic surgery may not necessarily extend to the peritoneal interface.

■ Further investigation on local peritoneal immunity is needed. The degree to which CO2 pneumoperitoneum suppresses macrophage function is uncertain, as available data are conflicting.

■ It is also impossible to draw firm conclusions with regards to bacterial clearance studies. At present, laparoscopic surgery appears to be equivalent to open surgery as regards oncological outcomes although long-term data are awaited.

■ High throughput tools such as microarray technology may improve the way immunological responses to laparoscopic surgery are studied.

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