Respuesta inflamatoria sistémica al TATME

Respuesta inflamatoria sistémica de la Escisión Mesorrectal Total Transanal (TaTME) por cáncer de recto

Systemic inflammatory response to transanal total mesorectal excision for rectal cancer

María Labalde Martínez*, Cristina Nevado García*, Óscar García Villar*, Esther Rubio González*, Pablo Miguel Peláez Torres*, 
Alfredo Vivas López*, Rafael Ramos Martínez*, Francisco Javier García Borda*, Eduardo Ferrero Herrero*

* Servicio de Cirugía General, Aparato Digestivo y Trasplante de Órganos Abdominales, Unidad de Cirugía Colorrectal, Hospital Universitario 12 de Octubre, Madrid

DOI: 10.14679/2322

Resumen: 

Introducción: La escisión mesorrectal total transanal (TaTME) del cáncer de recto es un procedimiento mínimamente invasivo que puede modificar la respuesta inflamatoria sistémica a la cirugía. El objetivo de este estudio es comparar los niveles de proteína C reactiva (PCR) y procalcitonina al 2º y 4º día postoperatorio en pacientes con cáncer de recto sometidos a TaTME y a resección anterior baja laparoscópica (RAB LPC). Material y métodos: 50 pacientes (14 mujeres 36 varones) con una mediana de edad de 67 (55,75-75,25) años con cáncer de recto fueron sometidos a cirugía: 20 mediante TaTME y 30 mediante RAB LPC. Se compararon los dos grupos (TaTME vs RAB LPC) según las características clínicas de los pacientes y del tumor, tiempo quirúrgico e indicadores de calidad de cirugía del cáncer de recto. Se compararon los niveles de PCR y procalcitonina al 2º y 4º DPO entre los dos grupos. Resultados: Las características clínicas de los pacientes y los indicadores de calidad del cáncer de recto fueron similares en los dos grupos. No se encontraron diferencias estadísticamente significativas en los niveles de PCR y procalcitonina al 2º y 4º DPO entre los dos grupos. La morbilidad postoperatoria está asociada a un aumento de los niveles de PCR al 4 DPO [OR=1,099 (IC95% 1,022-1,181), p=0,011]. Conclusión: La respuesta inflamatoria sistémica postoperatoria tras TaTME fue similar a la de la RAB LPC por cáncer de recto y la morbilidad postoperatoria está asociada a un aumento de los niveles de PCR al 4 DPO.
Palabras clave: Cáncer de recto, escisión mesorrectal toral transanal, respuesta inflamatoria sistémica, proteína C reactiva.

Abstract: 

Introduction. Transanal total mesorectal excision (TaTME) for rectal cancer is a minimally invasive surgical procedure that could modify the systemic inflammatory response to surgery. The aim of this study was to compare the values of C-reactive protein and procalcitonine in the second and fourth postoperative days of patients underwent TaTME and laparoscopic low anterior resection (TaTME vs LPC LAR) for rectal cancer. Methods. We included 50 patients (14 females and 36 males) with mean age of 67 years (range 55.75-75.25) who underwent rectal cancer surgery: 20 patients underwent TaTME and 30 LPC LAR. Clinical characteristics of patients and tumor, operative time and quality indicators for surgery of rectal cancer were analyzed in two groups (TaTME vs LPC LAR). We compared the values of C-reactive protein and procalcitonine in the second and fourth postoperative days between two groups. Results. There were not significant differences in relation to patients and tumor main characteristics operative time, and quality indicators for surgery of rectal cancer between two groups. There were not significant differences in relation to the values of C-reactive protein and procalcitonine in the second and fourth postoperative days between two groups. Postoperative morbidity rate was associated with values of C-reactive protein in the fourth postoperative day [OR=1.099 (CI95% 1.022-1.181), p=0.011].
Conclusion. Systemic inflammatory response to TaTME was similar to laparoscopic low anterior resection for rectal cancer. Postoperative morbidity rate was associated with values of C-reactive protein in the fourth postoperative day after rectal cancer surgery.
Key words : Rectal cancer, transanal total mesorectal excision, systemic inflammatory response, reactive C protein.

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