The effect of anesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway

Abstract

There are reports that the use of regional anesthesia (RA) may be associated with better perioperative surgical stress response in cancer patients compared with general anesthetics (GA). However, the role of anesthesia on the magnitude of the postoperative systemic inflammatory response (SIR) in colorectal cancer patients, within an enhanced recovery pathway (ERP), is not clear. The aim of the present study was to examine the effect of anesthesia, within an enhanced recovery pathway, on the magnitude of the postoperative SIR in patients undergoing elective surgery for colorectal cancer. Database of 507 patients who underwent elective open or laparoscopic colorectal cancer surgery between 2015 and 2019 at a single center was studied. The anesthetic technique used was categorized into either GA or GA + RA using a prospective proforma. The relationship between each anesthetic technique and perioperative clinicopathological characteristics was examined using binary logistic regression analysis. The majority of patients were male (54%), younger than 65 years (41%), either normal or overweight (64%), and were nonsmokers (47%). Also, the majority of patients underwent open surgery (60%) and received mainly general + regional anesthetic technique (80%). On univariate analysis, GA + RA was associated with a lower day 4 CRP (≤150/>150 mg/L) concentration. On day 4, postoperative CRP was associated with anesthetic technique [odds ratio (OR) 0.58; confidence interval (CI) 0.31–1.07; P = .086], age (OR 0.70; CI 0.50–0.98; P = .043), sex (OR 1.15; CI 0.95–2.52; P = .074), smoking (OR 1.57; CI 1.13–2.19; P = .006), preoperative mGPS (OR 1.55; CI 1.15–2.10; P = .004), and preoperative dexamethasone (OR 0.70; CI 0.47–1.03; P = .072). On multivariate analysis, day 4 postoperative CRP was independently associated with anesthetic technique (OR 0.56; CI 0.32–0.97; P = .039), age (OR 0.74; CI 0.55–0.99; P = .045), smoking (OR 1.58; CI 1.18–2.12; P = .002), preoperative mGPS (OR 1.41; CI 1.08–1.84; P = .012), and preoperative dexamethasone (OR 0.68; CI 0.50–0.92; P = .014). There was a modest but an independent association between RA and a lower magnitude of the postoperative SIR. Future work is warranted with multicenter RCT to precisely clarify the relationship between anesthesia and the magnitude of the postoperative SIR.

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

“…These studies found no difference in IL-6 levels between total intravenous anesthesia and inhalational anesthesia 24 h after surgery [ 56 , 57 ]. The type of anesthesia was not assessed in the present study, and we have no data on the use of regional anesthesia or preoperative dexamethasone, which may also impact the systemic inflammatory response after surgery [ 58 , 59 ].…”

Soluble Urokinase Receptor Levels Are Not Affected by the Systemic Inflammatory Response to Anesthesia and Operative Trauma

“…Other authors have also shown that suPAR is only modestly associated with CRP and is less sensitive to acute inflammation, implying that these biomarkers may represent different pathways along the inflammatory cascade [30]. Of note, CRP is known to increase postoperatively because of the surgical trauma but tends to normalize rapidly due to the effects of anesthetics, its short plasma half-life, or in cases of minimally invasive procedures or uncomplicated postoperative course [20, [31][32][33]. In contrast, perioperative su-PAR levels remain stable.…”