Metabolic and functional results after laparoscopic colorectal surgery: a randomized, controlled trial.
OBJECTIVE
This study was designed to compare metabolic and functional results after laparoscopic and open colorectal resection.


METHODS
Seventy-nine patients were randomly assigned to laparoscopic (n = 40) or open (n = 39) colorectal resection. Before and after operation, the following parameters were determined: respiratory function (spirography and blood gas); serum level of cortisol, lactate, and C-reactive protein; total lymphocyte count; and CD4 and CD8 lymphocyte subsets. Intraoperative core temperature was measured by a bladder probe. Postoperative pain and analgesic consumption were also monitored.


RESULTS
Mild operative hypothermia, a trend to postoperative reduction of total lymphocyte count, and significant impairment of respiratory function early after surgery were found in both groups. Laparoscopy showed a higher CD4/CD8 ratio (P = 0.01) on postoperative Day 1 and a faster return of C-reactive protein to preoperative values (P = 0.01) than in the open colorectal resection group. Morphine consumption in the first 48 hours after surgery was lower in the laparoscopic than in the open group (P = 0.02).


CONCLUSIONS
Laparoscopy was associated with a less pronounced immunosuppression and inflammatory response and a lower consumption of analgesic drugs than open surgery. Moreover, our data did not show any additional detrimental effect of laparoscopy on either operative core temperature or early postoperative respiratory function.
Department of Surgery, San Raffaele University, Milan, Italy.
Marco
M
Braga
Andrea
A
Vignali
Walter
W
Zuliani
Giovanni
G
Radaelli
Luca
L
Gianotti
Carla
C
Martani
Gilles
G
Toussoun
Valerio
V
Di Carlo
D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D015179:Colorectal Neoplasms / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007249:Inflammation; D007773:Lactates / Q000097:blood; D010535:Laparoscopy; D018655:Lymphocyte Count; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012129:Respiratory Function Tests; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D007773:Lactates; D002097:C-Reactive Protein; D006854:Hydrocortisone