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

Area of Science:

• Surgical Innovation
• Gastroenterology
• Oncology

Background:

• Pre-clinical data suggest dry-cold-carbon dioxide (DC-CO2) causes more peritoneal damage, inflammation, and hypothermia than humidified-warm-CO2 (HW-CO2).
• Comparison of peritoneal and core temperatures in colorectal cancer (CRC) patients undergoing surgery.

Purpose of the Study:

• To compare the effects of DC-CO2 and HW-CO2 insufflation on peritoneal integrity and core body temperature in patients undergoing colorectal cancer surgery.
• To evaluate the impact of different CO2 insufflation methods on inflammation and patient outcomes.

Main Methods:

• Randomized controlled trial (RCT) involving 66 patients for laparoscopic surgery (DC-CO2 vs. HW-CO2) and 19 patients for open surgery (conventional vs. HW-CO2 device).
• Monitoring of patient temperatures, collection of peritoneal biopsies and blood samples at multiple time points.
• Scanning electron microscopy used to assess mesothelial damage.

Main Results:

• Laparoscopic patients experienced temperature drops; HW-CO2 restored normothermia by 3 hours, unlike DC-CO2.
• Humidified-warm-CO2 insufflation was associated with shorter hospital stays (5.0 vs. 7.2 days for colon, 11.6 vs. 15.4 days for rectum).
• Increased peritoneal damage observed in DC-CO2 group; higher C-reactive protein levels in open surgery cases.

Conclusions:

• Findings align with animal studies, confirming HW-CO2 benefits in CRC surgery.
• HW-CO2 offers peritoneal mesothelium protection, reduced inflammation, and core-body temperature restoration.
• Highlights the need to consider pre-existing peritoneal damage in surgical patients.