Activation of nuclear factor kappa B and induction of migration inhibitory factor in tumors by surgical stress of laparotomy versus carbon dioxide pneumoperitoneum: an animal experiment

Surgical trauma may be associated with enhanced tumor growth and establishment. The authors studied the effect of carbon dioxide (CO2) pneumoperitoneum versus laparotomy on tumor necrosis factor-alpha (TNF alpha), migration inhibitory factor (MIF) expression, and nuclear factor kappa B (NF kappa B) activity in human gastric cancer. Nude mice were inoculated intraperitoneally with human gastric cancer cells (MKN45). Then laparotomy, CO2 pneumoperitoneum, and anesthesia alone were performed randomly. Tumor growth and associated TNF alpha and MIF expression and NF kappa B activity were determined. Total tumor weight, especially at the anterior abdominal wall, was higher after laparotomy than after CO2 pneumoperitoneum (p < 0.05). The mRNA expression of TNF alpha was higher 24 and 48 h after laparotomy than after CO2 pneumoperitoneum (p < 0.05 and p < 0.01, respectively). At all the examined time points, MIF mRNA expression also was higher after laparotomy than after CO2 pneumoperitoneum (p < 0.05 until 1 week or p < 0.01 at 2 weeks). The NF kappa B protein was more activated after laparotomy than after CO2 pneumoperitoneum 6 h subsequent to surgical procedures. After CO2 pneumoperitoneum, tumors have less TNF alpha and MIF expression and less NF kappa B activity than after laparotomy. This may be associated with less tumor growth, supporting minimal invasive techniques in gastrointestinal oncologic surgery.