Effect of Surgical Humidification on Inflammation and Peritoneal Trauma in Colorectal Cancer Surgery: A Randomized Controlled Trial

Sampurno, S; Chittleborough, T; Dean, M; Flood, M; Carpinteri, S; Roth, S; Millen, RM; Cain, H; Kong, JCH; MacKay, J; Warrier, SK; McCormick, J; Hiller, JG; Heriot, AG; Ramsay, RG; Lynch, AC

Author(s): Sampurno, S; Chittleborough, T; Dean, M; Flood, M; Carpinteri, S; Roth, S; Millen, RM; Cain, H; Kong, JCH; MacKay, J; Warrier, SK; McCormick, J; Hiller, JG; Heriot, AG; Ramsay, RG; Lynch, AC;
Details: Publication Year 2022-11,Volume 29,Issue #12,Page 7911-7920
Journal Title: Annals of Surgical Oncology
Publication Type: Research article
Abstract: BACKGROUND: Pre-clinical studies indicate that dry-cold-carbon-dioxide (DC-CO2) insufflation leads to more peritoneal damage, inflammation and hypothermia compared with humidified-warm-CO(2) (HW-CO2). Peritoneum and core temperature in patients undergoing colorectal cancer (CRC) surgery were compared. METHODS: Sixty-six patients were randomized into laparoscopic groups; those insufflated with DC-CO2 or HW-CO2. A separate group of nineteen patients undergoing laparotomy were randomised to conventional surgery or with the insertion of a device delivering HW-CO2. Temperatures were monitored and peritoneal biopsies and bloods were taken at the start of surgery, at 1 and 3 h. Further bloods were taken depending upon hospital length-of-stay (LOS). Peritoneal samples were subjected to scanning electron microscopy to evaluate mesothelial damage. RESULTS: Laparoscopic cases experienced a temperature drop despite Bair-Hugger(TM) use. HW-CO2 restored normothermia (>/= 36.5 degrees C) by 3 h, DC-CO2 did not. LOS was shorter for colon compared with rectal cancer cases and if insufflated with HW-CO2 compared with DC-CO2; 5.0 vs 7.2 days, colon and 11.6 vs 15.4 days rectum, respectively. Unexpectedly, one third of patients had pre-existing damage. Damage increased at 1 and 3 h to a greater extent in the DC-CO2 compared with the HW-CO2 laparoscopic cohort. C-reactive protein levels were higher in open than laparoscopic cases and lower in both matched HW-CO2 groups. CONCLUSIONS: This prospective RCT is in accord with animal studies while highlighting pre-existing damage in some patients. Peritoneal mesothelium protection, reduced inflammation and restoration of core-body temperature data suggest benefit with the use of HW-CO2 in patients undergoing CRC surgery.
Keywords: Animals; C-Reactive Protein; Carbon/pharmacology; Carbon Dioxide/pharmacology; *Colorectal Neoplasms/pathology/surgery; Humidity; Inflammation/etiology/pathology; *Insufflation; *Laparoscopy; Peritoneum/surgery; Prospective Studies
Department(s): Laboratory Research; Surgical Oncology; Anaesthetics
PubMed ID: 35794366
Publisher's Version: https://doi.org/10.1245/s10434-022-12057-3
Open Access at Publisher's Site: https://doi.org/10.1245/s10434-022-12057-3
Terms of Use/Rights Notice: Refer to copyright notice on published article.

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