Comparison of Inflammation, Pain, and Recovery in Colorectal Cancer Patients Undergoing Surgery with General Anesthesia and Combined Epidural

Ignatio Armando Kenzi; IGAG Utara  Hartawan; IGP Sukrana  Sidemen; Tjokorda Gde  Agung Senapathi; I Made  Gede Widnyana

doi:10.37899/journallamedihealtico.v6i2.2002

Ignatio Armando Kenzi Faculty of Medicine, Udayana University Denpasar
IGAG Utara Hartawan Faculty of Medicine, Udayana University Denpasar
IGP Sukrana Sidemen Faculty of Medicine, Udayana University Denpasar
Tjokorda Gde Agung Senapathi Faculty of Medicine, Udayana University Denpasar
I Made Gede Widnyana Faculty of Medicine, Udayana University Denpasar

DOI: https://doi.org/10.37899/journallamedihealtico.v6i2.2002

Keywords: Epidural anesthesia, IL-6, colorectal cancer, regional analgesia, Quality of Recovery-15

Abstract

Colorectal cancer has a high incidence and mortality rate. Surgery can increase the cytokine IL-6 which triggers inflammation and metastasis. The combination of general and epidural anesthesia has the potential to suppress IL-6, improve the tumor microenvironment, provide analgesia and improve postoperative recovery. To compare the effectiveness of postoperative analgesia quality in colorectal cancer patients receiving general anesthesia with combined epidural anesthesia. The single blind RCT study involved 44 patients who underwent surgery on colorectal cancer at Prof. Ngoerah Hospital. The study subjects were divided into two groups, group K who received general anesthesia and group P who received general anesthesia combined with epidural anesthesia. Patients' IL-6 will be evaluated preoperatively and 6 hours postoperatively. VAS and QOR-15 will be assessed 24 hours postoperatively. Of the 44 patients analyzed, the combined general anesthesia with epidural anesthesia group showed a significantly lower difference in IL-6 levels compared to the general anesthesia alone group of -14.69 [95% CI, p = <0.001]. The 24-hour postoperative VAS score was significantly lower than conventional general anesthesia, both in stationary and mobile conditions. In postoperative recovery, it was found that conventional general anesthesia combined with epdiural anesthesia gave greater QOR-15 results compared to conventional general anesthesia. General anesthesia combined with epidural anesthesia in colorectal cancer patients undergoing surgery can provide a lower difference in IL-6, lower VAS and higher QOR-15 postoperative satisfaction than the general anesthesia group.

References

Atmaja, R. F. D., Yuniarty, T., Misbah, S. R., & Malik, H. (2024). Effect of Pogostemon cablin Benth Extract on Interleukin-6, Blood Glucose, Hemoglobin and Hematocrit in Diethylnitrosamine-Induced Wistar Rats. Indonesian Journal of Phytopharmaca, 11(1), 17–22. https://doi.org/10.33096/jffi.v11i1.1092

Ben-David, B. (2016). Anaesthesia in cancer surgery: can it affect cancer survival? Current Clinical Pharmacology, 11(1), 4-20. https://doi.org/10.2174/1574884711666160122093154

Capdevila, X., Moulard, S., Plasse, C., Peshaud, J.-L., Molinari, N., Dadure, C., & Bringuier, S. (2017). Effectiveness of Epidural Analgesia, Continuous Surgical Site Analgesia, and Patient-Controlled Analgesic Morphine for Postoperative Pain Management and Hyperalgesia, Rehabilitation, and Health-Related Quality of Life After Open Nephrectomy: A Prospective, Randomized, Controlled Study. Anesthesia & Analgesia, 124(1). https://doi.org/10.1213/ane.0000000000001688

Elsayed, A. A., EI-deen, N. M. G., Shams, G. H. R., Aly, A. E. A., & Mohammed, W. S. (2020). Comparative Study between General Anesthesia versus General Anesthesia Combined with Thoracic Epidural Analgesia on Cytokine Response in Laparoscopic Cholecystectomy Patients. Open Journal of Anesthesiology, 10(6), 247-262. https://doi.org/10.4236/ojanes.2020.106022

Gu, C.-Y., Zhang, J., Qian, Y.-N., & Tang, Q.-F. (2015). Effects of epidural anesthesia and postoperative epidural analgesia on immune function in esophageal carcinoma patients undergoing thoracic surgery. Molecular and Clinical Oncology, 3(1), 190-196. https://doi.org/10.3892/mco.2014.405

Guay, J., Nishimori, M., & Kopp, S. L. (2016). Epidural local anesthetics versus opioid-based analgesic regimens for postoperative gastrointestinal paralysis, vomiting, and pain after abdominal surgery: a Cochrane review. Anesthesia & Analgesia, 123 (6), 1591-1602. https://doi.org/10.1213/ANE.0000000000001628

Hasselager, R. P., Hallas, J., & Gögenur, I. (2022). Epidural analgesia and recurrence after colorectal cancer surgery: a Danish retrospective registry-based cohort study. Anesthesiology, 136(3), 459-471. https://doi.org/10.1097/ALN.0000000000004132

Hou, B.-J., Du, Y., Gu, S.-X., Fan, J., Wang, R., Deng, H., Guo, D.-X., Wang, L., & Wang, Y.-Y. (2019). General anesthesia combined with epidural anesthesia maintaining appropriate anesthesia depth may protect excessive production of inflammatory cytokines and stress hormones in colon cancer patients during and after surgery. Medicine, 98(30), e16610. https://doi.org/10.1097/MD.0000000000016610

Kleif, J., & Gögenur, I. (2018). Severity classification of the quality of recovery-15 score—an observational study. Journal of Surgical Research, 225, 101-107. https://doi.org/10.1016/j.jss.2017.12.040

Liu, Q., Lin, J., Zhang, Y., Zhu, N., Wang, G., Wang, S., & Gao, P. (2020). Effects of epidural combined with general anesthesia versus general anesthesia on quality of recovery of elderly patients undergoing laparoscopic radical resection of colorectal cancer: a prospective randomized trial. Journal of Clinical Anesthesia, 62, 109742. https://doi.org/10.1016/j.jclinane.2020.109742

Mazda, Y., Jadin, S., & Kahn, J. (2021). Postoperative Pain Management. Canadian Journal of General Internal Medicine,16 , 5-17. https://doi.org/10.22374/cjgim.v16iSP1.529

Rahardjo, S., Widyastuti, Y., & Rumpoko, T. M. (2020). Immunologic Effects on Acute and Chronic Opioid Use. Journal of Anesthesia Complications, 7(3), 83-95. https://doi.org/10.22146/jka.v7i3.7479

Raharjo, W., Wibowo, A. A., Handaya, A. Y., Arifin, F., & Nugroho, A. (2022). Book Perioperative Pain Consensus in the Field of Digestive Surgery. FIB Unhas in collaboration with the Association of Digestive Surgery Specialists.

Rawla, P., Sunkara, T., & Barsouk, A. (2019). Epidemiology of colorectal cancer: incidence, mortality, survival, and risk factors. Gastroenterology Review/Przegląd Gastroenterologiczny, 14(2), 89-103. https://translate.google.com/website?sl=en&tl=id&hl=id&client=sge&u=https://doi.org/10.1055/s-0029-1242458

Rokom. (2022). Most Breast Cancer in Indonesia, Ministry of Health Targets Equitable Health Services. Healthy My Country.

Rudiman, R. (2023). A Comprehensive Approach to Colorectal Cancer. Jakad Media Publishing.

Shabaan, A. A. (2019). A randomized trial comparing three different anesthetic techniques on immune response for patients undergoing abdominal hysterectomy operation. Research and Opinion in Anesthesia & Intensive Care, 6(4), 446-454. https://doi.org/10.4103/roaic.roaic_55_18

Sulastri, F. D. W. I. (2024). The Relationship of Smoking History with the Incidence of Colorectal Cancer at Rsup H. Adam Malik Medan. Faculty of Medicine, Islamic University of North Sumatra.

Temesgen, M. H., Brihanu, A., & Teshome, Z. bekele. (2022). Post-operative pain assessment, management compliance with WHO guidelines and its barriers in hospitals of West Shoa zone, central of Ethiopia, 2021. Annals of Medicine and Surgery, 84 (August), 104901. https://doi.org/10.1016/j.amsu.2022.104901

Wahyuni, D., Wibowo, A. A., Oktaviyanti, I. K., Budiwinata, W., & Rosida, L. (2024). Relationship between the Degree of Differentiation and the Number of Lymphocyte Inflammatory Cells in Colorectal Cancer Histopathology. Homeostasis, 6(3), 627-638. https://doi.org/10.20527/ht.v6i3.11450

Wang, L., Liang, S., Chen, H., Xu, Y., & Wang, Y. (2019). The effects of epidural anaesthesia and analgesia on T lymphocytes differentiation markers and cytokines in patients after gastric cancer resection. BMC Anesthesiology, 19(1), 102. https://doi.org/10.1186/s12871-019-0778-7

Wu, H., Wang, S., Lv, H., Lou, F., Yin, H., Gu, Y., Zhang, J., & Xu, Y. (2023). Effect of thoracic epidural anesthesia on perioperative neutrophil extracellular trapping markers in patients undergoing anesthesia and surgery for colorectal cancer: A randomized, controlled trial. Annals of Surgical Oncology, 30(12), 7561-7568. https://doi.org/10.1245/s10434-023-14077-z

Xi, Y., & Xu, P. (2021). Global colorectal cancer burden in 2020 and projections to 2040. Translational Oncology, 14(10), 101174. https://doi.org/10.1016/j.tranon.2021.101174

Xu, Y. J., Chen, W. K., Zhu, Y., Wang, S. L., & Miao, C. H. (2014). Effect of thoracic epidural anaesthesia on serum vascular endothelial growth factor C and cytokines in patients undergoing anaesthesia and surgery for colon cancer. British Journal of Anaesthesia, 113 (suppl_1), i49-i55. https://doi.org/10.1093/bja/aeu148

Yanagimoto, Y., Takiguchi, S., Miyazaki, Y., Mikami, J., Makino, T., Takahashi, T., Kurokawa, Y., Yamasaki, M., Miyata, H., Nakajima, K., Mori, M., & Doki, Y. (2016). Comparison of pain management after laparoscopic distal gastrectomy with and without epidural analgesia. Surgery Today, 46(2), 229-234. https://doi.org/10.1007/s00595-015-1162-y