Abstract
A better understanding of antioxidant status, its modifiers, and its effect on clinical outcomes in patients undergoing colorectal cancer surgery is needed for effective antioxidant-based interventions. The objectives of this cohort study were: to determine baseline serum (total antioxidant capacity (TAC) and ferric reducing antioxidant power (FRAP); n = 72) and erythrocyte (superoxide dismutase (SOD) and glutathione peroxidase (GPx); n = 47) antioxidant capacity and time-course during the 72 h postoperative period, to identify potential modifiers, and to establish impact on clinical outcomes. Older patients with comorbidities had lower baseline FRAP. TAC was inversely and SOD directly correlated with inflammatory markers. Cancer pathology affected GPx (lower in advanced and more aggressive cancers) and SOD (higher in advanced cancers). Surgical intervention induced a transient increase in FRAP and TAC with greater FRAP elevation in older, obese patients with several comorbidities. SOD activity significantly increased while GPx non-significantly decreased between 8 and 24 h post-incision. Poorer health status was associated with an increase in SOD and a decrease in GPx at 72 h. Clinical manifestation of postoperative ileus was preceded by decreased TAC at 24 h and an increase in SOD between 8 and 24 h and anastomotic leak was manifested by diminished SOD at 72 h compared to activities at 8 and 24 h. The time-frame between 8 and 24 h post-incision might be the most critical regarding oxidant/antioxidant balance and therefore the best suited for antioxidant-based intervention.
Highlights
The possible association between antioxidant capacity and patient-related features
A better better understanding understanding of antioxidant status, its dynamics in the early postoperative period, and and association associationwith withclinical clinical outcomes as well asidentification an identification of potential outcomes as well as an of potential modmodifiers is needed for successful targeted antioxidant therapies
Patient age, and comorbidities are associated with diminished systemic antioxidant defense in colorectal cancer and alter antioxidant dynamics during the early postoperative period pointing to elderly patients with several comorbidities and/or with advanced cancer as those who may especially benefit from antioxidant therapy
Summary
Colorectal cancer (CRC) remains one of the most common types of cancer and the second-leading cause of cancer-related deaths [1] despite considerable progress made in its early diagnostics [2]. Surgical resection of the tumor and the removal of regional lymph nodes continue to be the mainstay of therapy for locoregional CRC [1]. In more advanced stages of disease multi-modality therapy with surgery, chemotherapy, and radiotherapy is often required [3]. Oxidative stress plays a crucial role in carcinogenesis and acts either by promoting or hampering tumor growth depending on the stage of the process [4]. It is believed to induce neoplastic transformation in the colon, especially in patients with inflammatory bowel
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