Acute inflammatory response to colorectal cancer resection according to different laparotomy incision lengths
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概要
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The aim of this study was to clarify a correlation between acute inflammatory response to surgery and different laparotomy lengths in patients who underwent colorectal cancer resection via a single minimal laparotomy. Between April 2005 and May 2008, 131 consecutive patients (59 women, 72 men), who were scheduled to undergo elective surgery for resection of primary colorectal cancer using a single minimal skin incision, were enrolled in this study to investigate the correlation between postoperative acute inflammatory responses (as measured by serum C-reactive protein (CRP) levels and white blood cell count (WBC)) and different laparotomy lengths. According to the length of laparotomy, the patients were grouped into 3 categories, "small-incision" ( 7 cm), "medium-incision" (>7 and 14 cm), and "large-incision" (>14 cm) for comparison. Statistical analyses were conducted using the Kruskal-Wallis test with multiple comparison post-hoc and chi-square tests. The small-, medium-, and large-incision groups included 68 (51.9%), 42, (32.1%) and 21 (16.0%) patients, respectively. On the 1st postoperative day, median serum levels of CRP and WBC of the small-incision group were significantly lower than those of the medium-incision and large-incision groups (CRP, P=0.0051 and P=0.0015, respectively; WBC, P=0.049 and P =0.0007, respectively). In addition, the median serum levels of CRP and WBC on the 1st postoperative day were proportional to the length of laparotomy. These data suggested that the extent of acute inflammatory response may be proportional to length of laparotomy. In addition, only the use of small-incisions ( 7 cm) among the three investigated categories of laparotomy lengths may be a factor which is associated with statistical significance with minimal invasiveness of colorectal cancer resection.