It is well known that surgery provokes an inflammatory response. However, the induced inflammatory response to laparoscopic compared with open surgery under combined anesthesia has never been compared following colorectal cancer surgery. We hypothesize that laparoscopic technique under general anesthesia results in a decreased proinflammatory state. We compared cytokines plasma secretion after laparoscopic technique under general anesthesia (LG), open surgery under combined anesthesia (thoracic epidural and general anesthesia) (OGE), and open surgery under general anesthesia as the control group (OG). Proinflammatory cytokines measured postoperatively were significantly increased in the OG group (n=19), compared with the LG (n=18) and OGE (n=20) groups. Post hoc analysis showed that CCL2 levels were significantly lower in LG at all times postoperatively (P<0.01), while interleukin-4, an anti-inflammatory cytokine, was increased in the OGE group (P<0.01). Laparoscopic technique blunts the postoperative proinflammatory response from the very early stages of the inflammatory cascade, whereas combined anesthesia is a more anti-inflammatory approach.
*Department of Anesthesiology and Intensive Care, Intensive Care Section
†Department of Anesthesiology and Intensive Care, Thoracic Section
‡Department of Anesthesiology and Intensive Care, Colorectal Section
∥Department of Surgery, Gregorio Marañon Hospital
§Biochemistry and Molecular Biology, Medical Faculty, Complutense University, Madrid, Spain
The authors declare no conflicts of interest.
Reprints: Patricia Duque, MD, PhD, Department of Anesthesiology and Intensive Care, Gregorio Marañon Hospital, Dr. Esquerdo 46, Madrid 28007, Spain (e-mail: email@example.com).
Received July 1, 2018
Accepted November 13, 2018