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Although systemic immune function is better preserved following laparoscopic procedures when compared with their respective open approaches, CO<jats:sub>2<\/jats:sub> pneumoperitoneum may significantly affect local (i.e., infra\u2010abdominal) cellular immunity by reducing regional macrophage function. Results to date are conflicting with regard to the impact of closed and open methods on intraabdominal immunity. Impaired cellular immunity after CO<jats:sub>2<\/jats:sub> pneumoperitoneum may have significant undesirable intra\u2010abdominal effects on tumor surveillance after oncological surgery; however, at present, there is no clinical evidence to support this position. The VATS techniques avoid the use of CO<jats:sub>2<\/jats:sub> insufflation, which may offer some advantages from the immune function perspective over laparoscopic procedures accomplished with CO<jats:sub>2<\/jats:sub> pneumoperitoneum. Better preservation of early postoperative cellular immune function and attenuated disturbance in the inflammatory mediators are likely contributing factors to the clinical benefits that follow laparoscopic surgery and VATS. Larger multi\u2010center randomized trials are needed to confirm the potential benefits of minimal\u2010access surgery on patient survival after cancer surgery. Future research should focus on the effects of minimal\u2010access surgery on other mediators (such as MMP\u20109, IGFBP\u20103, IL\u201012, IL\u201017, and IL\u201023) that may be important in tumor cell dissemination, deposition, and propagation in the early postoperative period. Furthermore, additional searches for other factors or mediators, heretofore unrecognized, should be carried out. Such studies will, we hope, increase our knowledge and understanding of the impact of surgery on immune and other physiologic functions.<\/jats:p>","DOI":"10.1007\/s00268-005-0029-6","type":"journal-article","created":{"date-parts":[[2005,6,27]],"date-time":"2005-06-27T16:56:59Z","timestamp":1119891419000},"page":"975-981","source":"Crossref","is-referenced-by-count":55,"title":["Is Minimal Access Surgery for Cancer Associated with Immunologic Benefits?"],"prefix":"10.1002","volume":"29","author":[{"given":"Calvin S. H.","family":"Ng","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery The Chinese University of Hong Kong, Prince of Wales Hospital Shatin N.T. 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