Journal
JOURNAL OF CLINICAL MEDICINE
Volume 10, Issue 4, Pages -Publisher
MDPI
DOI: 10.3390/jcm10040589
Keywords
metabolomics; mass spectrometry; hypothalamus– pituitary gland– adrenal glands axis; cortisol; stress response; surgical trauma; robotic surgery; minimal invasive surgery
Categories
Funding
- Ministry of Science and Higher Education [016/RID/2019/19]
- European Regional Development Fund,within Innovative Economy Operational Program
- Project WroVasc-Integrated Cardiovascular Centre
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This study aimed to investigate cortisol levels and changes in colorectal cancer patients undergoing open or robot-assisted surgery. The results showed that surgery type, estimated blood loss, and length of surgery significantly affected the cortisol time profile, and cortisol co-examined with C-reactive protein may be predictive of surgical site infections.
Excessive endocrine response to trauma negatively affects patients' well-being. Cortisol dynamics following robot-assisted colorectal surgery are unknown. We aimed at determining the impact of cancer pathology and surgery-related factors on baseline cortisol levels and analyzed its time-profile in colorectal cancer patients undergoing open or robot-assisted surgery. Cortisol levels were measured using liquid chromatography quadrupole time-of-flight mass spectrometry. Baseline cortisol was not associated with any patient- or disease-related factors. Post-surgery cortisol increased by 36% at 8 h and returned to baseline on postoperative day three. The cortisol time profile was significantly affected by surgery type, estimated blood loss, and length of surgery. Baseline-adjusted cortisol increase was greater in females at hour 8 and in both females and patients from open surgery group at hour 24. Solely in the open surgery group, cortisol dynamics paralleled changes in interleukin (IL)-1 beta, IL-10, IL-1ra, IL-7, IL-8 and tumor necrosis factor (TNF)-alpha but did not correlate with changes in IL-6 or interferon (IFN)-gamma at any time-point. Cortisol co-examined with C-reactive protein was predictive of surgical site infections (SSI) with high accuracy. In conclusion, patient's sex and surgery invasiveness affect cortisol dynamics. Surgery-induced elevation can be reduced by minimally invasive robot-assisted procedures. Cortisol and C-reactive protein as SSI biomarkers might be of value in the evaluation of safety of early discharge of patients.
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