Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery

• Verfasst von: Dehne, Sarah [VerfasserIn]
• Verfasst von: Kirschner, Lina [VerfasserIn]
• Verfasst von: Strowitzki, Moritz [VerfasserIn]
• Verfasst von: Kilian, Samuel [VerfasserIn]
• Verfasst von: Kummer, Laura [VerfasserIn]
• Verfasst von: Schneider, Martin [VerfasserIn]
• Verfasst von: Michalski, Christoph [VerfasserIn]
• Verfasst von: Büchler, Markus W. [VerfasserIn]
• Verfasst von: Weigand, Markus A. [VerfasserIn]
• Verfasst von: Larmann, Jan [VerfasserIn]
• Titel: Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery
• Verf.angabe: Sarah Dehne (MD), Lina Kirschner (MD), Moritz J. Strowitzki (MD, PhD), Samuel Kilian (MSc, PdD), Laura Christine Kummer (MSc), Martin A. Schneider (MD), Christoph W. Michalski (MD), Markus W. Büchler (MD) , Markus A. Weigand (MD), Jan Larmann (MD, PhD)
• E-Jahr: 2024
• Jahr: September 2024
• Umfang: 7 S.
• Illustrationen: Diagramme
• Fussnoten: Gesehen am 12.12.2024
• Titel Quelle: Enthalten in: Journal of clinical anesthesia
• Ort Quelle: Amsterdam [u.a.] : Elsevier Science, 1988
• Jahr Quelle: 2024
• Band/Heft Quelle: 96(2024) vom: Sept., Artikel-ID 111495, Seite [1]-7
• ISSN Quelle: 1873-4529
• DOI: doi:10.1016/j.jclinane.2024.111495
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: Carbon dioxide
• Sach-SW: Colorectal cancer surgery
• Sach-SW: Intraoperative ventilation
• Sach-SW: Postoperative complications
• Sach-SW: Recurrence-free survival
• K10plus-PPN: 191217958X

Abstract

Study objective - Higher levels of carbon dioxide (CO2) increase the invasive abilities of colon cancer cells in vitro. Studies assessing target values for end-tidal CO2 concentrations (EtCO2) to improve surgical outcome after colorectal cancer surgery are lacking. Therefore, we evaluated whether intraoperative EtCO2 was associated with differences in recurrence-free survival after elective colorectal cancer (CRC) surgery. - Design - Single center, retrospective analysis. - Setting - Anesthesia records, surgical databases and hospital information system of a tertiary university hospital. - Patients - We analyzed 528 patients undergoing elective resection of colorectal cancer at Heidelberg University Hospital between 2009 and 2018. - Interventions - None. - Measurements - Intraoperative mean EtCO2 values were calculated. The study cohort was equally stratified into low-and high-EtCO2 groups. The primary endpoint measure was recurrence-free survival until last known follow-up. Groups were compared using Kaplan-Meier analysis. Cox-regression analysis was used to control for covariates. Sepsis, reoperations, surgical site infections and cardiovascular events during hospital stay, and overall survival were secondary outcomes. - Main results - Mean EtCO2 was 33.8 mmHg ±1.2 in the low- EtCO2 group vs. 37.3 mmHg ±1.6 in the high-EtCO2 group. Median follow-up was 3.8 (Q1-Q3, 2.5-5.1) years. Recurrence-free survival was higher in the low-EtCO2 group (log-rank-test: p = .024). After correction for confounding factors, lower EtCO2 was associated with increased recurrence-free survival (HR = 1.138, 95%-CI:1.015-1.276, p = .027); the hazard for the primary outcome decreased by 12.1% per 1 mmHg decrease in mean EtCO2. 1-year and 5-year survival was also higher in the low-EtCO2 group. We did not find differences in the other secondary endpoints. - Conclusions - Lower intraoperative EtCO2 target values in CRC surgery might benefit oncological outcome and should be evaluated in confirmative studies.