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

Alhayyan, Aliah M.; McSorley, Stephen T.; Kearns, Rachel; Horgan, Paul G.; Roxburgh, Campbell S.D.

doi:10.1371/journal.pone.0228580

Cited by 5 publications

(3 citation statements)

References 22 publications

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“…Regional anaesthesia is reported to suppresses the incidence of postoperative complications after gastrointestinal surgery. 26,27 Beta-blocker therapy is also thought to protect against major complications after gastrointestinal surgery. 28,29 As regional anaesthesia impedes the neural transmission from the periphery to the central nervous system, it might play a role in reducing the nociceptive response index during surgery.…”

Section: Discussionmentioning

confidence: 99%

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Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia

Ogata

Matsuki

Okamoto

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Surgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available. OBJECTIVES To identify associations between major complications after gastrointestinal surgery and intra-operative quantitative values from intra-operative nociception monitoring. DESIGN A multi-institutional observational study. SETTING Two university hospitals. PATIENTS Consecutive adult patients undergoing gastrointestinal surgery under general anaesthesia. MAIN OUTCOME MEASURES Averaged values of nociceptive response index from start to end of surgery (mean NR index) and risk scores of the Surgical Mortality Probability Model (S-MPM) were calculated. Pre and postoperative serum C-reactive protein (CRP) levels were obtained. After receiver-operating characteristic (ROC) curve analysis, all patients were divided into groups with high and low mean nociceptive response index. Associations between mean nociceptive response index and postoperative major complications, defined as Clavien-Dindo grade at least IIIa, were examined using logistic regression analysis. RESULTS ROC curve analysis showed a nociceptive response index cut-off value for major complications of 0.83, and we divided patients into two groups with mean nociceptive response index less than 0.83 and at least 0.83. The incidence of major complications was significantly higher in patients with mean nociceptive response index at least 0.83 (23.1%; n = 346) than in patients with mean nociceptive response index less than 0.83 (7.7%; n = 443; P < 0.001). Multivariate analysis revealed emergency surgery, S-MPM risk score, mean nociceptive response index and postoperative CRP levels as independent risk factors for major complications. CONCLUSION Mean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery. TRIAL REGISTRATION The current observational study had no intervention, and was therefore, not registered.

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Section: Discussionmentioning

confidence: 99%

“…Regional anaesthesia is reported to suppresses the incidence of postoperative complications after gastrointestinal surgery 26,27 . Beta-blocker therapy is also thought to protect against major complications after gastrointestinal surgery 28,29 .…”

Section: Discussionmentioning

confidence: 99%

Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia

Ogata

Matsuki

Okamoto

et al. 2021

European Journal of Anaesthesiology

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“…[ 5 ] Furthermore, these authors, in a retrospective audit of the effect of anesthetic technique on the magnitude of the postoperative CRP in patients undergoing elective open or laparoscopic surgery for colon cancer, reported that the magnitude of the postoperative SIR in particular, POD 2 CRP, was modulated by the induction of RA in patients who underwent open surgery, but not laparoscopic surgery for colorectal cancer. [ 6 ]…”

Section: Introductionmentioning

confidence: 99%

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

Alhayyan

McSorley²,

Kearns³

et al. 2021

Medicine

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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.

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Perioperative intravenous dexamethasone for patients undergoing colorectal surgery: a systematic review and meta-analysis

McKechnie

Elder

Ichhpuniani

et al. 2023

Int J Colorectal Dis

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

Cited by 5 publications

References 22 publications

Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia

Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia

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

Perioperative intravenous dexamethasone for patients undergoing colorectal surgery: a systematic review and meta-analysis

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