Please use this identifier to cite or link to this item:
Title: Effect of surgical humidification on inflammation and peritoneal trauma in colorectal cancer surgery: A randomized controlled trial.
Epworth Authors: Dean, Meara
McKay, John
Warrier, Satish
McCormick, Jacob
Hiller, Jonathon
Heriot, Alexander
Lynch, A. Craig
Ramsay, Robert
Other Authors: Sampurno, Shienny
Chittleborough, Tim
Flood, Michael
Charpinteri, Sandra
Roth, Sara
Millen, Rosemary
Cain, Helen
Kong, Joseph
Keywords: Colorectal Cancer Surgery
CRC Surgery
Peintoneal Damage
Peritoneal Mesothelium Protection
General Surgery & Gastroenterology Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Jul-2022
Publisher: Springer
Citation: Ann Surg Oncol. 2022 Jul 6;1-10.
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-CO2 (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-HuggerTM 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.
DOI: 10.1245/s10434-022-12057-3
PubMed URL:
ISSN: 1068-9265
Journal Title: Annals of Surgical Oncology
Type: Journal Article
Affiliated Organisations: Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia.
Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia.
Type of Clinical Study or Trial: Randomized Controlled Clinical Trial
Appears in Collections:Cancer Services

Files in This Item:
File Description SizeFormat  
Satish.pdf561.05 kBAdobe PDFThumbnail

Items in Epworth are protected by copyright, with all rights reserved, unless otherwise indicated.