College of Medical, Veterinary and Life of Sciences, School of Medicine, Department of Surgery.
School of Medicine, Academic Unit of Surgery.
Medicine (Baltimore). 2021 Jan 15;100(2):e23997. doi: 10.1097/MD.0000000000023997.
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.
有报道称，与全身麻醉（GA）相比，区域麻醉（RA）的使用可能与癌症患者围手术期手术应激反应的改善相关。然而，在增强康复途径（ERP）内，麻醉对结直肠癌患者术后全身炎症反应（SIR）程度的影响尚不清楚。本研究旨在研究在 ERP 中，麻醉对接受择期结直肠手术的患者术后 SIR 程度的影响。
研究回顾性分析了 2015 年至 2019 年在一家单中心接受择期开腹或腹腔镜结直肠癌手术的 507 例患者的数据库。使用前瞻性方案表将使用的麻醉技术分为 GA 或 GA+RA。使用二元逻辑回归分析检查每种麻醉技术与围手术期临床病理特征之间的关系。
大多数患者为男性（54%），年龄小于 65 岁（41%），体重正常或超重（64%），不吸烟（47%）。此外，大多数患者接受开腹手术（60%），主要接受全身+区域麻醉技术（80%）。单因素分析显示，GA+RA 与术后第 4 天 CRP（≤150/>150mg/L）浓度较低有关。术后第 4 天，CRP 与麻醉技术有关[比值比（OR）0.58；95%置信区间（CI）0.31-1.07；P=0.086]，与年龄（OR 0.70；95%CI 0.50-0.98；P=0.043）、性别（OR 1.15；95%CI 0.95-2.52；P=0.074）、吸烟（OR 1.57；95%CI 1.13-2.19；P=0.006）、术前 mGPS（OR 1.55；95%CI 1.15-2.10；P=0.004）和术前地塞米松（OR 0.70；95%CI 0.47-1.03；P=0.072）有关。多因素分析显示，术后第 4 天 CRP 与麻醉技术独立相关（OR 0.56；95%CI 0.32-0.97；P=0.039），与年龄（OR 0.74；95%CI 0.55-0.99；P=0.045）、吸烟（OR 1.58；95%CI 1.18-2.12；P=0.002）、术前 mGPS（OR 1.41；95%CI 1.08-1.84；P=0.012）和术前地塞米松（OR 0.68；95%CI 0.50-0.92；P=0.014）有关。RA 与术后 SIR 程度的降低之间存在适度但独立的关联。需要进行多中心 RCT 以进一步阐明麻醉与术后 SIR 程度之间的关系。
