How inflammation effect in combined epidural general anesthesia in hemicolectomy colorectal cancer ?
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Impact of Inflammation in Combined Epidural-General Anesthesia for Hemicolectomy in Colorectal Cancer
Introduction to Combined Epidural-General Anesthesia
Combined epidural-general anesthesia (CEGA) is increasingly being used in colorectal cancer surgeries, such as hemicolectomy, due to its potential benefits in managing pain and reducing surgical stress. This article explores how inflammation is affected by CEGA in the context of hemicolectomy for colorectal cancer patients.
Inflammatory Response and Immune Modulation
Effects on Inflammatory Cytokines
Research indicates that CEGA can significantly modulate the inflammatory response during and after colorectal cancer surgery. Specifically, CEGA has been shown to reduce levels of pro-inflammatory cytokines such as tumor necrosis factor (TNF)-α and interleukin (IL)-6, as well as stress hormones like cortisol and adrenocorticotropic hormone (ACTH). This reduction is particularly notable within the first 24 hours post-surgery, suggesting that CEGA can mitigate the immediate inflammatory response triggered by surgical trauma.
Impact on Immune Cells
CEGA also positively influences immune cell counts. Studies have demonstrated that CEGA can increase the postoperative counts of natural killer (NK) cells and CD4+ T cells, which are crucial for the body's immune defense against cancer cells. However, other immune parameters such as CD3+ cell count, CD4+/CD8+ ratio, and levels of IL-6 and TNF-α remain unaffected by the type of anesthesia used.
Long-term Outcomes and Survival
Long-term Survival and Recurrence
Despite the short-term benefits in reducing inflammation and modulating immune responses, long-term studies have not shown a significant improvement in overall or cancer-specific survival rates with CEGA compared to general anesthesia alone. This suggests that while CEGA may offer immediate postoperative benefits, its impact on long-term cancer outcomes remains uncertain.
Cognitive Function and Stress Response
In elderly patients, CEGA has been associated with better postoperative cognitive function and a reduced stress response. This is evidenced by lower levels of inflammatory markers such as IL-1, IL-6, and TNF-α, as well as stress hormones like norepinephrine and epinephrine. These findings highlight the potential of CEGA to improve overall postoperative recovery and reduce the incidence of cognitive disorders in elderly patients undergoing major surgeries.
Comparison with Other Anesthetic Techniques
Laparoscopic vs. Open Surgery
The type of surgical approach also plays a significant role in the inflammatory response. Laparoscopic surgery, when combined with general anesthesia, has been shown to result in a lower pro-inflammatory state compared to open surgery with CEGA. This suggests that the surgical technique may have a more substantial impact on inflammation than the type of anesthesia used.
Enhanced Recovery After Surgery (ERAS) Protocols
The implementation of ERAS protocols, which often include the use of epidural anesthesia, has been shown to reduce postoperative inflammation and improve short-term recovery outcomes such as complication rates and length of hospital stay. High compliance with ERAS protocols further enhances these benefits, although the effect on inflammation is relatively small.
Conclusion
Combined epidural-general anesthesia offers several benefits in managing inflammation and immune responses during and after hemicolectomy for colorectal cancer. It reduces pro-inflammatory cytokines and stress hormones, enhances immune cell counts, and improves postoperative cognitive function in elderly patients. However, its impact on long-term survival and cancer recurrence remains inconclusive. The choice of surgical technique and adherence to ERAS protocols also play crucial roles in modulating the inflammatory response and improving surgical outcomes. Further research is needed to fully understand the long-term implications of CEGA in colorectal cancer surgeries.
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