Rim.А. Gilfanova1, 2, Z.А. Afanasyeva2
¹Republican Clinical Hospital, Kazan
²Kazan State Medical Academy — Branch Campus of the FSBEI FPE RMACPE MOH Russia, Kazan
Gilfanova R.A. — surgeon of the Department of Radiosurgical Diagnostics and Treatment Methods No. 2
138 Orenburgsky Trakt, build. A, 420064 Kazan, Russian Federation, tel.: +7-982-998-10-66, e-mail: rimma-gilfanova@mail.ru
Abstract. Surgical treatment of colorectal cancer triggers a systemic inflammatory response (SIR), a complex cascade of neuroendocrine and immune reactions to injury [1]. The SIR severity directly correlates with the risk of postoperative complications and can negatively impact long-term oncologic outcomes [2]. Most patients with CRC, especially elderly ones, have a significant comorbidity burden, which in itself is a factor in chronic low-grade inflammation (so-called “inflammaging”) and can potentiate the body’s stress response to surgery [3, 4]. However, the relationship between the comorbidity level and the postoperative SIR intensity has not been adequately studied. Modern anesthetic approaches, in particular regional blocks, are considered not only as an analgesia means but also as a way to influence SIR [5]. Transversus Abdominis Plane Block (TAP) of the abdomen, by blocking afferent nociceptive impulses, can reduce the release of stress hormones and proinflammatory cytokines. This creates conditions for attenuating the inflammatory response, which is important for patients with comorbidities.
The purpose — to evaluate the impact of comorbidity on the dynamics of SIR laboratory markers in patients after surgical treatment for colorectal cancer.
Material and methods. The prospective study included 106 patients with colorectal cancer, divided into an observation group (n = 53, TAP block + systemic analgesia) and a comparison group (n = 53, systemic analgesia only). We assessed levels of leukocytes, lymphocytes, platelets, C-reactive protein (CRP), and N/L (neutrophil-lymphocyte) and L/M (lymphocyte-monocyte) indices on the third day after surgery. Comorbidity was assessed using Charlson index.
Results. Patients with a high comorbidity index (≥5 points) in the comparison group showed the most pronounced SIR signs: the platelet level was 291.71 ± 85.20 × 10⁹/L versus 248.30 ± 81.92 × 10⁹/L in the TAP blockade group (p = 0,02). At stage III of the disease, a statistically significant advantage in the L/M index was noted in the observation group (2.11 [1.19; 3.69] versus 1.52 [0.94; 2.61], p = 0.039). TAP blockade contributed to the stabilization of CRP levels regardless of the comorbidity’s severity (p = 0.30).
Conclusion. High comorbidity is associated with a more intense SIR in the postoperative period. The inclusion of TAP block in the multimodal analgesia regimen allows limiting the severity of the inflammatory reaction, which is confirmed by the dynamics of lymphocyte and CRP indicators; however, to assess the independent contribution of factors, a multivariate analysis is required.
Key words: colorectal cancer, comorbidity, Charlson index, systemic inflammatory response, TAP block, lymphocytes, platelets, C-reactive protein