The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .
Toll-like receptors in the inflammatory response during open and laparoscopic colectomy for colorectal cancer
Background Surgical interventions activate a cascade of reactions that result in an aseptic inflammatory reaction . This inflammatory response initiates the organism ’s innate immunity . Laparoscopic surgery reduces the trauma , and patients benefit from diminished surgical trauma and maintained immune function . Cytokine levels and C-reactive protein ( CRP ) are related to the magnitude of surgical trauma and surgical stress . Toll-like receptors ( TLRs ) 2 and 4 are the first sensor-recognition receptors of the invading pathogens for the innate immune response . This study aim ed to compare the inflammatory response and then the stress response during laparoscopic and open colectomy for cancer by calculating TLR-2 and TLR-4 as the first sensor-recognition receptors together with interleukin-6 ( IL-6 ) , tumor necrosis factor-α ( TNF-α ) , and high-sensitivity CRP ( hsCRP ) . Methods A total 40 patients with colorectal cancer were r and omized in two groups : group A ( open colectomy , n = 20 ) and group B ( laparoscopic colectomy , n = 20 ) .  An epidural catheter was placed in all patients 1 h preoperatively . Rupivocaine was administered perioperatively and 48 h postoperatively . Blood sample s were taken for calculation of IL-6 , TNF-α , hsCRP , TLR-2 , and TLR-4 preoperatively and 5 min after deflation of pneumoperitoneum ( group B ) or 5 min after division of the colon ( group A ) , then 6 and 24 h postoperatively . Results The mean operative time was 115 for group A and 142 min for group B. The mean blood loss was respectively 240 and 105 ml ( P < 0.001 ) , and the mean hospital stay was respectively 8 and 5 days ( P < 0.05 ) . The IL-6 level was significant higher in group A than in group B at 6 and 24 h postoperatively ( P < 0.0001 ) , and the hsCRP level was significant higher in group A than in group B at 24 h postoperatively ( P < 0.001 ) . The TNF-α values did not differ between the two groups . The TLR-2 level was significantly higher in group A than in group B at 5 min ( P = 0.013 ) and 24 h ( P = 0.007 ) postoperatively . The TLR-4 level was significant higher in group A than in group B at 5 min postoperatively ( P = 0.03 ) . Conclusion The inflammatory response and the result ant stress response are significantly less during laparoscopic colectomy than during open colectomy for colorectal cancer . This is an obvious short-term clinical benefit for the patient , providing tinder for further study to investigate the long-term results of laparoscopic colectomy versus open colectomy for colorectal cancer ( Registered clinical trial no. NCT00942461 ; www . clinical trials.gov )
The present systematic review shows that , with the exception of laparoscopic surgery , objective evidence of the effect of individual components of ERAS protocol s in reducing the stress response following colorectal surgery is limited
Abstract Enhanced Recovery or Fast Track Recovery after Surgery protocol s ( ERAS ) have significantly changed perioperative care following colorectal surgery and are promoted as reducing the stress response to surgery .