Quality of Recovery and Innate Immune Homeostasis in Patients Undergoing Low- Versus Standard pressure Pneumoperitoneum During Laparoscopic Colorectal Surgery (RECOVER): A Randomized Controlled Trial.

Fecha de publicación: 13/07/2022 Fecha Ahead of Print: 13/07/2022

Autores de IIS La Fe

• 

  Óscar Díaz Cambronero

  Autor

• Guido Mazzinari

  Autor

Participantes ajenos a IIS La Fe

• Albers, I, Kim
• Polat, Fatih
• Helder, Leonie
• Panhuizen, Ivo F.
• Snoeck, Marc M. J.
• Polle, S. (Bas) W.
• de Vries, Hilbert
• Dias, Esther M.
• Slooter, Gerrit D.
• de Boer, Hans D.
• Scheffer, Gert-Jan
• Keijzer, Christiaan
• Warle, Michiel C.

Grupos

• Medicina Perioperatoria, Anestesiología y Reanimación

  

  Leader

  Óscar Díaz Cambronero

Abstract

OBJECTIVE: To study the effects of intra-abdominal pressure on the quality of recovery and innate cytokine production capacity after laparoscopic colorectal surgery within the enhanced recovery after surgery program. BACKGROUND: There is increasing evidence for the safety and advantages of low-pressure pneumoperitoneum facilitated by deep neuromuscular blockade (NMB). Nonetheless, there is a weak understanding of the relationship between clinical outcomes, surgical injury, postoperative immune dysfunction, and infectious complications. METHODS: Randomized controlled trial of 178 patients treated at standard-pressure pneumoperitoneum (12mmHg) with moderate NMB (train-of-four 1-2) or low pressure (8mmHg) facilitated by deep NMB (posttetanic count 1-2). The primary outcome was the quality of recovery (Quality of Recovery 40 questionnaire) on a postoperative day 1 (POD1). The primary outcome of the immune substudy (n=100) was ex vivo tumor necrosis factor alpha production capacity upon endotoxin stimulation on POD1. RESULTS: Quality of Recovery 40 score on POD1 was significantly higher at 167 versus 159 [mean difference (MD): 8.3 points; 95% confidence interval (CI): 2.5, 14.1; P =0.005] and the decline in cytokine production capacity was significantly less for tumor necrosis factor alpha and interleukin-6 (MD: -172pg/mL; 95% CI: -316, -27; P =0.021 and MD: -1282pg/mL; 95% CI: -2505, -59; P =0.040, respectively) for patients operated at low pressure. Low pressure was associated with reduced surgical site hypoxia and inflammation markers and circulating damage-associated molecular patterns, with a less impaired early postoperative ex vivo cytokine production capacity. At low pressure, patients reported lower acute pain scores and developed significantly less 30-day infectious complications. CONCLUSIONS: Low intra-abdominal pressure during laparoscopic colorectal surgery is safe, improves the postoperative quality of recovery and preserves innate immune homeostasis, and forms a valuable addition to future enhanced recovery after surgery programs.

Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.

Keywords

• laparoscopy; laparoscopic surgery; low pressure pneumoperitoneum; intra-abdominal pressure; deep neuromuscular blockade; QoR-40; DAMPs; innate immunity; postoperative infections