Abstract
Excessive endocrine response to trauma negatively affects patients’ well-being. Cortisol dynamics following robot-assisted colorectal surgery are unknown. We aimed at determining the impact of cancer pathology and surgery-related factors on baseline cortisol levels and analyzed its time-profile in colorectal cancer patients undergoing open or robot-assisted surgery. Cortisol levels were measured using liquid chromatography quadrupole time-of-flight mass spectrometry. Baseline cortisol was not associated with any patient- or disease-related factors. Post-surgery cortisol increased by 36% at 8 h and returned to baseline on postoperative day three. The cortisol time profile was significantly affected by surgery type, estimated blood loss, and length of surgery. Baseline-adjusted cortisol increase was greater in females at hour 8 and in both females and patients from open surgery group at hour 24. Solely in the open surgery group, cortisol dynamics paralleled changes in interleukin (IL)-1β, IL-10, IL-1ra, IL-7, IL-8 and tumor necrosis factor (TNF)-α but did not correlate with changes in IL-6 or interferon (IFN)-γ at any time-point. Cortisol co-examined with C-reactive protein was predictive of surgical site infections (SSI) with high accuracy. In conclusion, patient’s sex and surgery invasiveness affect cortisol dynamics. Surgery-induced elevation can be reduced by minimally invasive robot-assisted procedures. Cortisol and C-reactive protein as SSI biomarkers might be of value in the evaluation of safety of early discharge of patients.
Highlights
Cortisol, the primary glucocorticoid, is released in reaction to the activation of the hypothalamus–pituitary gland–adrenal glands (HPA) axis
Since cortisol has a profound effect on protein, carbohydrate, and lipid metabolism as well as on immune and inflammatory response [1,2], it is being tested as a candidate biomarker in diverse pathological states [3,4,5]
We evaluated its dynamics in the perioperative period in patients with colorectal cancer undergoing open and robotic surgery using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS)
Summary
The primary glucocorticoid, is released in reaction to the activation of the hypothalamus–pituitary gland–adrenal glands (HPA) axis. Cortisol is essential for maintaining homeostasis following trauma by regulating the synthesis of catecholamines and adrenergic receptors and maintaining vascular tone [6]. While it is well known that cortisol concentration rapidly increases in the response to surgery-induced trauma, both its dynamics in the perioperative period and the relevant modifying factors are not clearly defined [7]. The vast majority of available data has been obtained from small and heterogeneous studies, in which cortisol had been quantified using immunoenzymatic assays [7]. We adapted methyl tert-butyl ether (MTBE) liquid–liquid extraction method [9,10] for cortisol quantification. We evaluated its dynamics in the perioperative period in patients with colorectal cancer undergoing open and robotic surgery using liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS)
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