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

• Published in: Annals of surgical oncology Vol. 29; no. 12; pp. 7911 - 7920
• Main Authors: Sampurno, Shienny, Chittleborough, Timothy, Dean, Meara, Flood, Michael, Carpinteri, Sandra, Roth, Sara, Millen, Rosemary M., Cain, Helen, Kong, Joseph C. H., MacKay, John, Warrier, Satish K., McCormick, Jacob, Hiller, Jonathon G., Heriot, Alexander G., Ramsay, Robert G., Lynch, Andrew C.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.11.2022; Springer Nature B.V
• Subjects: Biopsy; Body temperature; C-reactive protein; Carbon dioxide; Colon cancer; Colorectal Cancer; Colorectal carcinoma; Hypothermia; Inflammation; Laparoscopy; Medicine; Medicine & Public Health; Mesothelium; Oncology; Patients; Peritoneum; Scanning electron microscopy; Surgery; Surgical Oncology; Trauma
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-022-12057-3

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 °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.