Effect of the enhanced recovery after surgery (ERAS) protocols on the immune response in open vs laparoscopic colorectal surgery

Martinez, Ana B. (Universidad de Zaragoza) ; Ramírez, José M. (Universidad de Zaragoza) ; Calvo, Beatriz (Universidad de Zaragoza) ; Gracia, José A. (Universidad de Zaragoza) ; Guillén, Julia (Universidad de Zaragoza) ; Longás, Javier (Universidad de Zaragoza)

Resumen: Objectives: In this study we aimed to identify the immune response in patients undergoing colorectal cancer surgery within an ERAS protocol and to determine whether significantly different responses were found between open and laparoscopic surgery. Serious injury is quickly followed by the systemic inflammatory response syndrome, which can lead to death. Understanding the immune response of surgical patients allows modifying it according to the surgery or anaesthetic chosen. Also, the perioperative care can attenuate the stress response to surgery and enable rapid recovery.

Methods: The analysis included 38 patients undergoing elective colorectal surgery for cancer within an ERAS Protocol at the Hospital Lozano Blesa in Zaragoza (Spain). These patients were divided into two groups according to the type of surgery: open surgery (group 1, n=19) and laparoscopic surgery (group 2, n=19).

Plasma levels of CRP, haemogram, immunoglobulins and lymphocyte profile were measured at three time points: m0 (immediately before surgery), m1 (24 hours postoperatively) and m3 (72 hours postoperatively).

Results: There were no significant differences in patient characteristics between groups in terms of gender, age and BMI. Levels of CRP were significant higher in G1 at m2 and m3. The count of lymphocytes was higher in G2 at m2. However, neutrophils levels were lower in the same group. The study of T and B cells subsets showed a significant higher CD4 and CD19 levels in G2 at m2. NK cells count was significant lower in the same group at m3. There were no significant differences in the levels of immunoglobulin between groups.

Conclusion: This study demonstrates that laparoscopic surgery appears to be associated with similar immune responses compared with open surgery, considering that immune parameters vary slightly between groups. Although higher CRP levels showed a high level of injury in the open surgery group, the management of perioperative care through an ERAS protocol seemed to minimise the effect of open surgery associated to more postoperative complications. Further studies are be required in order to clarify the significance of the different levels of CD4, CD19 and CD56 found among groups.

Idioma: Inglés

DOI: 10.1016/j.clnesp.2016.02.017

Año: 2016

Publicado en: Clinical Nutrition ESPEN 12 (2016), e34-e35
ISSN: 2405-4577

Factor impacto SCIMAGO: 0.156 - Nutrition and Dietetics (Q4) - Endocrinology, Diabetes and Metabolism (Q4)

Tipo y forma: Congress (Published version)

Área (Departamento): Área Enfermería (Dpto. Fisiatría y Enfermería)
Área (Departamento): Área Fisiología (Dpto. Farmacología y Fisiolog.)
Área (Departamento): Área Cirugía (Dpto. Cirugía,Ginecol.Obstetr.)