Inflammatory response modulation by prehabilitation therapy in colonic surgery

Abstract

Objectives: Surgical procedures have been associated to transient immunosuppressed states. There are many factors related to the inflammatory response modulation: both surgical and anaesthetic ones and those attached to patients. An adequate response of the immune system is relevant in oncological patients eligible for major surgery, therefore it becomes important to perform proper preoperative optimisation by prehabilitation therapy. The present study assessed the modulation of the inflammatory response by the prehabilitation therapy in patients undergoing colonic surgery. Methods: Forty patients undergoing colonic surgery were included in a prospective study. Patients were allocated to two different groups: Prehabilitation Group (PG) and Non-prehabilitation group (CG). All patients were managed with an enhanced recovery programme. Peripheral blood samples were taken for studying leucocyte populations and C-reactive protein (CRP) levels in three perioperative time points: M1: baseline, M2: at 24 hours posptoperatively, M3: at 72 hours postoperatively. Data analysis was performed with SPSS 17.0 software. A normality test was applied and Student’s t Test was used for independent samples. A p-value <0.05 was considered statistically significant. Results: No group differences in demographic and anthropometric variables were found. Statistically significant differences were found between groups in CRP levels in M1 and M2 with higher values in CG. Regarding the leucocyte populations, CG showed higher leucocyte levels in M1 and M2 samples (p<0.05). Lymphocyte and monocyte levels were statistically higher in PG at M2. Conclusion: Initial results of this study showed a better modulation of the inflammatory response according to leucocytes and CRP levels in the prehabilitation group. The result obtained at 24 hours postoperatively in this group concerning the larger increase of lymphocyte and monocyte counts, seems interesting regarding modulation of cells in the oncological patient. Further studies are needed to determine if this increase is persistent and to identify which leucocyte populations are involved. We conclude that prehabilitation seems to play an important role in the modulation of postsurgical inflammatory response, a relevant fact in oncological patients. Disclosure of interest: None declared.