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Surgical and not analgesic technique affects postoperative Inflammation following colorectal cancer surgery: a prospective, randomized study
Orebro University Hospital. Department of Anesthesiology and Intensive Care, University Hospital Örebro, Örebro, Sweden.
Department of Anesthesiology and Intensive care, County Council of Östergötland, Linköping, Sweden.
Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Malmö, Sweden.
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2017 (English)In: Colorectal Disease, ISSN 1462-8910, E-ISSN 1463-1318Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIM: Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery.

METHODS: 96 patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient controlled intravenous analgesia (group P). Surgery and anaesthesia were standardized in both groups. Plasma cortisol, insulin and serum cytokines (IL-1β,IL-4,IL-5,IL-6,IL-8,IL-10,IL-12p70,IL-13,TNFα,IFNγ,GM-CSF,PGE2 and VEGF) were measured preoperatively (T0), 1-6 hours postoperatively (T1) and 3-5 days postoperatively (T2). Mixed model analysis was used, after logarithmic transformation when appropriate, for analyses of cytokines and stress markers.

RESULTS: There were no significant differences in any serum cytokine concentration between groups P and E at any time point except in IL-10 which was 87% higher in group P (median and range 4.1 (2.3-9.2) pg/ml,) compared to group E (2.6 (1.3-4.7) pg/ml) (p=0.002) at T1. There was no difference in plasma cortisol and insulin between the groups at any time point after surgery. Significant difference in median serum cytokine concentration was found between open and laparoscopic surgery with higher levels of IL-6,IL-8 and IL-10 at T1 in patients undergoing open surgery compared to laparoscopic surgery. No difference in serum cytokine concentration was detected between the groups or between the surgical technique at T2.

CONCLUSIONS: Open surgery, compared to laparoscopic surgery, has greater impact on these inflammatory mediators than epidural analgesia vs. intravenous analgesia. This article is protected by copyright. All rights reserved.

Place, publisher, year, edition, pages
John Wiley & Sons, 2017.
Keyword [en]
Anaesthesia, epidural, cytokines, inflammation, surgery: colorectal cancer
National Category
Anesthesiology and Intensive Care Cancer and Oncology Surgery
Research subject
Oncology; Surgery; Anaesthesiology
Identifiers
URN: urn:nbn:se:oru:diva-57387DOI: 10.1111/codi.13643PubMedID: 28258664OAI: oai:DiVA.org:oru-57387DiVA: diva2:1092732
Available from: 2017-05-03 Created: 2017-05-03 Last updated: 2017-05-08Bibliographically approved

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