The relationship between anaesthetic technique, clinicopathological characteristics and the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colon cancer.

Aliah M Alhayyan,Stephen T Mcsorley,Rachel J Kearns,Paul G Horgan,Donald C Mcmillan,Campbell S D Roxburgh

doi:10.1371/journal.pone.0228580

Abstract

Background/aimThe magnitude of the postoperative systemic inflammatory response (SIR) is now recognised to be associated with both short and long-term outcomes in patients undergoing surgery for colon cancer. During such surgery, it is unclear whether the anaesthetic regimens influence the magnitude of the postoperative SIR, independent of other factors. The aim of the present study was to examine the association between anaesthetic agents, clinicopathological characteristics and the magnitude of the postoperative SIR in patients undergoing elective surgery for colon cancer.MethodsPatients with colon cancer who underwent elective open or laparoscopic surgery between 2008 and 2016 (n = 409) were studied at a single center. The relationship between type of anaesthesia, surgical technique; open (n = 241) versus laparoscopic (n = 168) and clinicopathological characteristics was examined by using chi-square testing. The chi-square test was used to determine which anaesthetic group influences the POD 2 CRP for only patients undergoing elective open colon surgery.ResultsThe majority of patients were <75 years old, male, normal weight or obese, underwent open surgery and had regional anaesthesia, in particular an epidural approach. There was a significant association between type of anaesthesia and post-operative CRP on day 2 (p <0.001) in patients undergoing open surgery but not laparoscopic surgery. Other factors associated with type of anaesthesia included; year of operation (p <0.01), surgical technique (p <0.001), and preoperative dexamethasone (p <0.01).ConclusionIn patients undergoing surgery for elective colon cancer, the type of anaesthesia varied over time. The type of anaesthesia appears to influence the magnitude of the postoperative SIR on post-operative day 2 in open surgery but not laparoscopic surgery. Future work using prospective study design is required to better define this relationship.

Highlights

Surgical resection remains the mainstay of treatment for patients with non-metastatic solid tumours
In patients undergoing surgery for elective colon cancer, the type of anaesthesia varied over time
The type of anaesthesia appears to influence the magnitude of the postoperative systemic inflammatory response (SIR) on post-operative day 2 in open surgery but not laparoscopic surgery

Summary

Introduction

Surgical resection remains the mainstay of treatment for patients with non-metastatic solid tumours. The magnitude of the post-operative CRP response has been shown to be associated with post-operative complications [4]. A threshold of a CRP >150 mg/L on day 3 or day 4 has been shown to be associated with the development of post-operative complications and greater hospital stay [5]. With the establishment of a post-operative CRP threshold, potential factors giving rise to an elevated post-operative CRP are being increasingly identified in operable colorectal cancer. To date the pre-operative factors identified to independently modulate the SIR following surgery include age, ASA grade, BMI, pre-operative modified Glasgow Prognostic Score (mGPS) and most recently preoperative corticosteroids [4, 6] and these should be incorporated into any analysis of the effect of anaesthesia

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