Effect of laparoscopic radical resection on gastrointestinal function, oxidative stress, and immune function in patients with colorectal cancer

doi:10.3877/cma.j.issn.1674-0785.2022.04.008

Abstract

Abstract:

Objective

To investigate the effect of laparoscopic radical resection on gastrointestinal function, oxidative stress, and immune function in patients with colorectal cancer.

Methods

A total of 113 patients with colorectal cancer admitted to Xingtai People's Hospital from January 2018 to December 2020 were prospectively selected, and randomly divided into either a laparoscopic group (n=57) or a laparotomy group (n=56) using the random number table method. The laparoscopic group received laparoscopic radical resection, while the laparotomy group underwent open radical resection. Perioperative indicators (including intraoperative blood loss, operation time, and hospital stay), recovery of gastrointestinal function after surgery, and postoperative complications were recorded preoperative. Gastrointestinal hormones [gastrin and motilin], oxidative stress indicators [superoxide dismutase (SOD) and malondialdehyde (MDA)], and immune function indexes [immunoglobulin (Ig)A, IgG, and IgM] before surgery and at 24 h and 72 h after surgery were also recorded.

Results

Intraoperative blood loss was less, and operation time and hospital stay were shorter in the laparoscopic group than in the laparotomy group (P＜0.05). The time to first exhaust and time to food intake were shorter in the laparoscopic group than in the laparotomy group (P＜0.05). The postoperative complications in the laparoscopic group were less than those of the laparotomy group (P＜0.05). The levels of gastrin and motilin at 24 h and 72 h after surgery were higher in the laparoscopic group than in the laparotomy group (P＜0.05). SOD level was higher and MDA level was lower in the laparoscopic group than in the laparotomy group at 24 h and 72 h after surgery (P＜0.05). The levels of IgA, IgG, and IgM in the laparoscopic group were higher than those in the laparotomy group at 24 h and 72 h after surgery (P＜0.05).

Conclusion

Laparoscopic radical resection can promote the recovery of gastrointestinal function in patients with colorectal cancer, has fewer postoperative complications, and has little effect on patients' oxidative stress and immune function.

Key words: Laparoscopic radical resection, Colorectal cancer, Gastrointestinal function, Oxidative stress, Immune function

Hui Li, Dengxiang Liu, Hua Li. Effect of laparoscopic radical resection on gastrointestinal function, oxidative stress, and immune function in patients with colorectal cancer[J]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(04): 332-336.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlcyszz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0785.2022.04.008

https://zhlcyszz.cma-cmc.com.cn/EN/Y2022/V16/I04/332

Figures/Tables 7

组别	例数	性别［例（%）］		年龄（岁， $x ¯$ ±s）	体质量指数（kg/m²， $x ¯$ ±s）	肿瘤长径（cm， $x ¯$ ±s）	肿瘤类型［例（%）］		TNM分期［例（%）］
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	体质量指数（kg/m²， $x ¯$ ±s）	肿瘤长径（cm， $x ¯$ ±s）	结肠癌	直肠癌	Ⅰ期	Ⅱ期	Ⅲ期
腹腔镜组	57	35（61.40）	22（38.60）	59.87±6.78	22.83±2.14	3.48±0.72	26（45.61）	31（54.39）	10（17.54）	26（45.61）	21（36.85）
开腹组	56	37（66.07）	19（33.93）	59.24±7.95	22.65±2.23	3.54±0.89	24（42.86）	32（57.14）	13（23.21）	25（44.64）	18（32.14）
t/χ²值		0.266		0.454	0.438	0.394	0.087		0.633
P值		0.43		0.82	0.79	0.54	0.10		1.14

组别	例数	性别［例（%）］		年龄（岁， $x ¯$ ±s）	体质量指数（kg/m²， $x ¯$ ±s）	肿瘤长径（cm， $x ¯$ ±s）	肿瘤类型［例（%）］		TNM分期［例（%）］
组别	例数	男	女	年龄（岁， $x ¯$ ±s）	体质量指数（kg/m²， $x ¯$ ±s）	肿瘤长径（cm， $x ¯$ ±s）	结肠癌	直肠癌	Ⅰ期	Ⅱ期	Ⅲ期
腹腔镜组	57	35（61.40）	22（38.60）	59.87±6.78	22.83±2.14	3.48±0.72	26（45.61）	31（54.39）	10（17.54）	26（45.61）	21（36.85）
开腹组	56	37（66.07）	19（33.93）	59.24±7.95	22.65±2.23	3.54±0.89	24（42.86）	32（57.14）	13（23.21）	25（44.64）	18（32.14）
t/χ²值		0.266		0.454	0.438	0.394	0.087		0.633
P值		0.43		0.82	0.79	0.54	0.10		1.14

组别	例数	术中出血量（ml）	手术时间（min）	住院时间（d）
腹腔镜组	57	84.24±14.15	78.93±16.76	12.28±3.25
开腹组	56	109.87±23.27	97.94±18.53	19.95±4.08
t值		7.088	5.721	11.063
P值		0.02	0.01	0.03

组别	例数	排气时间（h）	进食时间（h）
腹腔镜组	57	42.13±7.84	54.27±8.46
开腹组	56	71.23±12.05	82.09±9.57
t值		15.243	16.380
P值		0.02	0.02

组别	例数	切口感染	肺部感染	肠梗阻	吻合口漏	总发生情况
腹腔镜组	57	1（1.75）	1（1.75）	0（0）	1（1.75）	3（5.26）
开腹组	56	4（7.14）	3（5.35）	2（3.57）	3（5.35）	12（21.43）
χ²值						6.412
P值						0.01

组别	例数	胃泌素（ng/L）			胃动素（ng/L）
组别	例数	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h
腹腔镜组	57	187.59±23.47	143.23±17.98^ab	175.23±21.29^ab	278.86±20.56	207.63±17.87^ab	259.71±23.12^ab
开腹组	56	189.02±20.13	102.07±14.58^a	132.09±18.65^a	280.07±25.43	168.54±19.29^a	208.04±26.76^a

组别	例数	SOD（U/L）			MDA（nmol/L）
组别	例数	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h
腹腔镜组	57	87.91±4.52	76.67±3.18^ab	82.45±3.45^ab	7.64±1.65	9.82±1.20^ab	8.74±1.04^ab
开腹组	56	89.03±3.79	65.84±4.67^a	76.31±4.02^a	7.58±1.41	12.23±1.68^a	9.98±1.23^a

组别	例数	IgA（g/L）			IgG（g/L）			IgM（g/L）
组别	例数	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h	术前	术后24 h	术后72 h
腹腔镜组	57	3.76±0.43	2.51±0.37^ab	2.89±0.30^ab	9.76±0.54	8.57±0.48^ab	9.21±0.43^ab	1.92±0.23	1.35±0.17^ab	1.68±0.25^ab
开腹组	56	3.69±0.40	1.95±0.32^a	2.31±0.28^a	9.82±0.56	7.86±0.54^a	8.62±0.39^a	1.93±0.28	1.02±0.20^a	1.32±0.19^a

References 17

1	Blondy S, David V, Verdier M, et al. 5-fluorouracil resistance mechanisms in colorectal cancer: from classical pathways to promising processes [J]. Cancer Sci, 2020, 111(9): 3142-3154.
2	Yu HY, Hemminki K. Genetic epidemiology of colorectal cancer and associated cancers [J]. Mutagenesis, 2020, 35(3): 207-219.
3	苑萌. 腹腔镜根治术与开放手术治疗TNM Ⅱ、Ⅲ期结肠直肠癌患者的效果比较 [J]. 实用临床医药杂志, 2019, 23(2): 83-86.
4	沈华, 倪春华, 吴作友, 等. 腹腔镜结直肠癌根治术治疗结直肠癌的效果及对血管生成通路遗传变异的影响 [J]. 中国肿瘤外科杂志, 2021, 13(2): 160-163.
5	张晓, 余先昊. 腹腔镜结直肠癌根治术对老年结直肠癌患者术后胃肠功能恢复的影响 [J]. 中国老年学杂志, 2021, 41(11): 2283-2286.
6	Legrand N, Dixon DA, Sobolewski C. Stress granules in colorectal cancer:current knowledge and potential therapeutic applications [J].World J Gastroenterol, 2020, 26(35): 5223-5247.
7	Hirko KA, Lennon SA, Lucas T, et al. Improving colorectal cancer screening in a rural setting: a randomized study [J]. Am J Prev Med, 2020, 59(3): 404-411.
8	李斌, 江媛, 胡玉娟. 腹腔镜手术与传统开腹手术在结直肠癌根治术中的临床效果 [J]. 中国医药导报, 2017, 14(17): 88-91.
9	戴毅, 韦华玉. 腹腔镜与开腹结直肠癌根治术的临床效果观察 [J]. 结直肠肛门外科, 2017, 23(3): 396-399.
10	汤红, 雷秀兵, 柴秀丽. 腹腔镜结直肠癌根治术患者血清CYFRA21-1、CA724水平变化与复发转移的关系 [J]. 中国实验诊断学, 2021, 25(5): 709-712.
11	孙广文, 颜松龄, 张国伟, 等. 腹腔镜下结直肠癌根治术的近期疗效及预后影响因素分析 [J]. 癌症进展, 2020, 18(12): 1267-1270, 1293.
12	徐竹林, 胥彬, 刘贤, 等. 腹腔镜直肠癌根治术中保留左结肠动脉对直肠癌患者胃肠功能、免疫系统及远期预后的影响 [J]. 实用癌症杂志, 2020, 35(6): 1000-1004.
13	魏微微, 张雪梅, 田浩, 等. 腹腔镜结直肠癌根治术对结直肠癌患者细胞免疫功能、胃肠激素及预后的影响 [J]. 中国内镜杂志, 2018, 24(12): 1-6.
14	左浩, 闫冬升, 冯爱文, 等. 腹腔镜对结直肠癌患者血清基质金属蛋白酶、胃肠激素及应激激素水平的影响 [J]. 现代生物医学进展, 2018, 18(23): 4514-4517, 4543.
15	肖俊, 张洁. 全身麻醉联合硬膜外麻醉对结直肠癌患者脑肠肽、肠屏障功能及氧化应激反应的影响 [J]. 实用临床医药杂志, 2020, 24(8): 58-62.
16	苏德望, 朱艳丽, 杜井峰, 等. 腹腔镜结直肠癌根治术对结直肠癌患者氧化应激及能量代谢的影响 [J]. 重庆医学, 2019, 48(10): 1787-1789.
17	张玉丹, 庄玉芬, 张洛. 不同入路腹腔镜手术对结直肠癌患者血清肿瘤因子及免疫功能的影响 [J]. 中华保健医学杂志, 2021, 23(2): 192-194.

[1]	Li Dai, Huiwei Deng, Huajing Guo, Furong Huang. Effect of continuous infusion of esketamine on postoperative sleep quality of patients undergoing laparoscopic colorectal cancer surgery [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(06): 408-412.
[2]	Fengyi Li, Ruofan Li, Xu Gao, Chaofan Zhang. Effect of target-directed liquid intervention on postoperative hemodynamics and gastrointestinal function recovery in elderly patients with gastrointestinal tumors [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(01): 29-32.
[3]	Tingting Li, Heyu Wu, Yue Zhang, Kang Cheng, Xiaofang Zhang, Yachan Cheng. Study on the application of combined insulation strategy in laparoscopic anatomic hepatectomy in elderly patients [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2023, 17(05): 522-525.
[4]	Jun Liu, Ji Zhu, Jun Yin. Anesthesia effect and safety of dexmedetomidine in inguinal hernia surgery [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 570-573.
[5]	Runzhi Chen, Dongmei Yang, Huiting Xu. PD-1 combined with surufatinib for the treatment of metastatic colon cancer with microsatellite stability and BRAF V600E mutation: A case report and review [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2023, 12(05): 431-435.
[6]	Huijuan Shang, Xiaodong Yuan. Improvement of prognosis of acute cerebral ischemic stroke with edaravone dexkanol after mechanical thrombectomy [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(05): 295-301.
[7]	Yong Zou, Yingjiang Gu, Hao Ding, Chenghao Yang, Minhui Chen, Yu Cai. Effects of puerarin on early inflammatory and oxidative stress responses involving the Nrf2/HO-1 and NF-κB signaling pathways after intracerebral hemorrhage in rat models [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2023, 13(05): 271-277.
[8]	Xiaona Wang, Wei Tan, Yue Li, Wenyan Jiang. Effects of predictive care on perioperative quality of life, mood, and complication in patients undergoing radical colorectal cancer surgery [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 525-529.
[9]	Wenlong Liang, Jie Cao, Qing Huang, Yong Lin, Hongli Huang, Ping Yang, Guanwei Li, He Hu. Efficacy and safety analysis of sintilimab combined with regofenib in the treatment of advanced colorectal cancer [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 409-413.
[10]	Daijiang Liu, Junyan Jiang, Xiaoqiang Wan, Shaying Ma. Analysis of survival status and prognostic factors in patients with colorectal cancer with liver metastasis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(05): 284-288.
[11]	Yongsheng Li, Jiahe Sun, Shuwei Guo, Yikang Lu, Hongzhou Liu. Short-term postoperative complications and their influencing factors in elderly patients with colorectal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(9): 962-967.
[12]	Feifei Wang, Guanglin Wang, Zesong Meng, Baokun Li, Longfei Cao, Juan Zhang, Chaoxi Zhou, Yuanyi Ding, Guiying Wang. Effect of IMPDH1 knockdown on biological behavior of human colon cancer SW480 and HT29 cells [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 884-890.
[13]	Fanbiao Kong, Jianrong Yang. Progress in understanding of relationship between underlying liver diseases and liver metastasis of colorectal cancer [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(07): 818-822.
[14]	Minjie Zhang, Xiaoshan Zhang, Shasha Duan, Yilu Shi, Jie Zhao, Tianhao Bai, Yaxi Wang. Hydrogen for treatment of myocardial ischemia-reperfusion injury: mechanism and prospect [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 744-748.
[15]	Yadan Wang, Jing Wu, Boyang Huang, Miaomiao Wang, Chunmei Guo, Hui Su, Canghai Wang, Jing Wang, Pengpeng Ding, Hong Liu. Design and validation of white-light endoscopy model for predicting the nature of colorectal tumors [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(06): 655-661.

Please choose a citation manager

Content to export