Comparison of inflammatory responses following robotic and open colorectal surgery: a prospective study.
OBJECTIVE
Robotic colorectal surgery continues to rise in popularity, but there remains little evidence on the stress response following the procedure. The aim of this study was to evaluate the inflammatory response to robotic colorectal surgery and compare it with the response generated by open colorectal surgery.


METHODS
This was a prospective nonrandomized comparative study involving 61 patients with colorectal cancer. The evaluation of inflammatory response to either robotic or open colorectal surgery was expressed as changes in interleukin-1β, interleukin-1 receptor antagonist, interleukin-6, tumor necrosis factor-α, C-reactive protein, and procalcitonin during the first three postoperative days.


RESULTS
Of the 61 patients, 33 underwent robotic colorectal surgery while 28 had open colorectal surgery. Groups were comparable with respect to age, sex, BMI, cancer stage, and type of resection. The relative increase of interleukin-1 receptor antagonist at 8 h postoperative, compared to baseline, was higher in the open group (P = 0.006). The decrease of interleukin-1 receptor antagonist on postoperative days 1 and 3, compared to the maximum at 8 h, was more pronounced in the open group than in the robotic group (P = 0.008, P = 0.006, respectively), and the relative increase of interleukin-6 at 8 h after incision was higher in the open group (P = 0.007). The relative increase of procalcitonin on postoperative days 1 and 3 was higher in the open group than the robotic group (P < 0.001, P = 0.004, respectively).


CONCLUSIONS
This study shows that when compared with open colorectal surgery, robotic colorectal surgery results in a less pronounced inflammatory response and more pronounced anti-inflammatory action.
Department of Surgical Oncology, Regional Specialist Hospital, Research and Development Centre at Regional Specialist Hospital, ul. Kamienskiego 73a, 51-124, Wroclaw, Poland. zawadzkimd@gmail.com.
Marek
http://orcid.org/0000-0001-8957-5625
M
Zawadzki
Department of Medical Biochemistry, Wroclaw Medical University, ul. Chalubinskiego 10, 50-368, Wroclaw, Poland. malgorzata.krzystek-korpacka@umed.wroc.pl.
Malgorzata
M
Krzystek-Korpacka
Department of Medical Biochemistry, Wroclaw Medical University, ul. Chalubinskiego 10, 50-368, Wroclaw, Poland.|Laboratory of Medical Microbiology, Ludwik Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw, Poland.
Andrzej
A
Gamian
Department of Surgical Oncology, Regional Specialist Hospital, Research and Development Centre at Regional Specialist Hospital, ul. Kamienskiego 73a, 51-124, Wroclaw, Poland.
Wojciech
W
Witkiewicz
D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D002116:Calcitonin / Q000097:blood; D003107:Colorectal Surgery / Q000009:adverse effects*; D016207:Cytokines; D003710:Demography; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000473:pathology*; D008297:Male; D019990:Perioperative Care; D011446:Prospective Studies; D012371:Robotics; D016896:Treatment Outcome
D016207:Cytokines; D002116:Calcitonin; D002097:C-Reactive Protein
Colorectal cancer; Inflammatory response; Robotic surgery; Stress response