Markers of tissue damage and inflammation after robotic and abdominal hysterectomy in early endometrial cancer: a randomised controlled trial

Abstract

The aim of this study was to analyse the dynamics of tissue damage and inflammatory response markers perioperatively and whether these differ between women operated with robotic and abdominal hysterectomy in treating early-stage endometrial cancer. At a Swedish university hospital fifty women with early-stage low-risk endometrial cancer were allocated to robotic or abdominal hysterectomy in a randomiszed controlled trial. Blood samples reflecting inflammatory responses (high sensitivity CRP, white blood cells (WBC), thrombocytes, IL-6, cortisol) and tissue damage (creatine kinase (CK), highmobility group box 1 protein (HMGB1)) were collected one week preoperatively, just before surgery, postoperatively at two, 24 and 48 hours, and one and six weeks postoperatively. High sensitivity CRP (p = 0.03), WBC (p < 0.01), IL-6 (p = 0.03) and CK (p = 0.03) were significantly lower in the robotic group, but fast transitory. Cortisol returned to baseline two hours after robotic hysterectomy but remained elevated in the abdominal group comparable to the preoperative high levels for both groups just before surgery (p < 0.0001). Thrombocytes and HMGB1 were not affected by the mode of surgery. Postoperative inflammatory response and tissue damage were lower after robotic hysterectomy compared to abdominal hysterectomy. A significant remaining cortisol elevation two hours after surgery may reflect a higher stress response in the abdominal group.

Sex, Type of Surgery, and Surgical Site Infections Are Associated with Perioperative Cortisol in Colorectal Cancer Patients

“…Within this grade, we were able to demonstrate that robot-assisted colorectal surgery elicited less marked cortisol elevation than a more invasive open procedure. Similar observations have been made for laparoscopic and open cholecystectomy [ 48 ], robotic radical prostatectomy and open retropubic approach [ 49 ], and for robotic and open hysterectomy [ 50 ].…”

Tissue trauma and inflammatory response following laparoscopic versus abdominal hysterectomy: a prospective randomized clinical trial

“…In patients undergoing hysterectomy, CRP levels were lower after laparoscopic hysterectomy than abdominal surgery. 1,6,11,18 To the contrary, other researchers found no post-operative difference in CRP between abdominal and laparoscopic hysterectomy, and the authors asserted that this was related to the longer operation time or extensive electrocoagulation in the laparoscopy group. 11 In agreement with previous studies, the post-operative increase in levels of CRP was significantly higher in the laparotomy group than in the laparoscopy group.…”

“…6 Increasing interest in laparoscopic hysterectomy has occurred since it was first reported in 1989. 1 Several studies comparing abdominal and laparoscopic hysterectomy, found the later to more beneficial in terms of lower complication rate, less postoperative pain, less blood loss, shorter hospital stay, shorter healing time and earlier return to daily activities. 2,6 Still, studies report that laparoscopic hysterectomy takes longer operative time than abdominal hysterectomy.…”

“…This overall effect is commonly referred to as the stress response to surgery. 1 The magnitude of the stress response is roughly proportional to the severity of surgery and this has an influence on the postoperative complications and the patients' convalescence and morbidity, therefore, many investigators have attempted to find ways to evaluate the stress response to surgery. 2 Hysterectomy is the most common major gynecologic operation performed worldwide, with two main approaches for benign uterine diseases: abdominal hysterectomy and laparoscopic hysterectomy.…”

Minimally-invasive-perventricular-device-occlusion versus surgical-closure for treating perimembranous-ventricular-septal-defect: 3-year outcomes of a multicenter randomized clinical trial

“…Although without extra oral digitalis and diuretic drugs for 3 months like the surgical group, the MIPDO group showed comparable perioperative cardiac performance including the postoperative diminution of left atrial diameter, left ventricular end-diastolic dimension and right ventricular diameter, these immediate outcomes of MIPDO were consistent with the expected hemodynamic change: once the VSD was closed, the overloaded right ventricle and left atrium would tent to become normalized and initiate structural remodeling. Furthermore, patients in the MIPDO group showed minor elevation of WBC, CK, LDH and BUN, outgrowth of slighter inflammatory response (27) and milder renal function impairment (28,29). Although patients in MIPDO group were prescribed with heparin and oral aspirin, they presented similar or even less variation in PLT compared with surgical groups.…”