title: Surgical and not analgesic technique affects postoperative inflammation following colorectal cancer surgery: a prospective, randomized study.
abstract: OBJECTIVE
  Epidural analgesia reduces the surgical stress response. However, its effect on pro- and anti-inflammatory cytokines in the genesis of inflammation following major abdominal surgery remains unclear. Our main objective was to elucidate whether perioperative epidural analgesia prevents the inflammatory response following colorectal cancer surgery.
  
  
  METHODS
  Ninety-six patients scheduled for open or laparoscopic surgery were randomized to epidural analgesia (group E) or patient-controlled intravenous analgesia (group P). Surgery and anaesthesia were standardized in both groups. Plasma cortisol, insulin and serum cytokines [interleukin 1β (IL-1β), IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumour necrosis factor α, interferon γ, granulocyte-macrophage colony-stimulating factor, prostaglandin E2and vascular endothelial growth factor] were measured preoperatively (T0), 1-6 h postoperatively (T1) and 3-5 days postoperatively (T2). Mixed model analysis was used, after logarithmic transformation when appropriate, for analyses of cytokines and stress markers.
  
  
  RESULTS
  >There were no significant differences in any serum cytokine concentration between groups P and E at any time point except for IL-10 which was 87% higher in group P [median and range 4.1 (2.3-9.2) pg/ml] compared to group E [2.6 (1.3-4.7) pg/ml] (P = 0.002) at T1. There was no difference in plasma cortisol and insulin between the groups at any time point after surgery. A significant difference in median serum cytokine concentration was found between open and laparoscopic surgery with higher levels of IL-6, IL-8 and IL-10 at T1 in patients undergoing open surgery compared to laparoscopic surgery. No difference in serum cytokine concentration was detected between the groups or between the surgical technique at T2.
  
  
  CONCLUSIONS
  Open surgery, compared to laparoscopic surgery, has greater impact on these inflammatory mediators than epidural analgesia vs intravenous analgesia.
authors.affiliation: Department of Anaesthesiology and Intensive Care, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: W
authors.initials: W
authors.lastname: Siekmann
authors.affiliation: Department of Anesthesiology and Intensive Care, County Council of Östergötland, Linköping, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Eintrei
authors.affiliation: Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Magnuson
authors.affiliation: Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Malmö, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Sjölander
authors.affiliation: Department of Surgery, Örebro University Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Matthiessen
authors.affiliation: Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.|Department of Surgery, Linköping University Hospital, Linköping, Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Myrelid
authors.affiliation: Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Gupta
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D015179:Colorectal Neoplasms / Q000601:surgery; D016207:Cytokines / Q000097:blood; D013505:Digestive System Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007328:Insulin / Q000097:blood; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000097:blood / Q000188:drug therapy*; D011184:Postoperative Period; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000700:Analgesics; D016207:Cytokines; D007328:Insulin; D006854:Hydrocortisone
keywords: Anaesthesia; colorectal cancer; cytokines; epidural; inflammation; surgery