Operative Stress Response, Energy Metabolism And Visceral Proteins After Laparoscopic-assisted Resection Of Rectal Carcinoma

Objective To compare the differences between laparoscopic-assisted and openresection of rectal carcinoma in respect of peri-operative levels of C-reactive protein(CRP),rest energy expenditure (REE), and visceral proteins.Methods According to patients' choice of operation, ether laparoscopic-assisted (n=20, Laparoscopic Group) or open (n=25, Open Group) resection of rectal carcinomawas performed. The levels of CRP and visceral proteins - including albumin(ALB),prealbumin(PRE), transferrin(TRF) and retinal-binding protein(RBP) - were assayedpreoperatively and on the 1st, 2nd and 3rd day postoperatively. The levels of REE werealso measured by indirect calorimetry in the morning.Results Compared to the preoperative period, the CRP levels in both groups wereincreased significantly on the 1st, 2nd and 3rd day (P＜0.01) and peaked on the 2nd daypostoperatively. The postoperative CRP levels were significantly lower in theLaparoscopic Group than in the Open Group (P＜0.01). After operation, the REE levelswere significantly increased in both groups (P＜0.05, P＜0.01), with the responses in theLaparoscopic Group significantly lower than those in the Open Group on the 1st and 3rdday postoperatively (P＜0.05). The levels of ALB, PRE, TRF and RbP were significantlydecreased after operation in both groups (P＜0.01). There was no significant differencebetween the two groups in levels of ALB, PRE, TRF and RbP on the 1st postoperativeday (P＞0.05). The levels of PRE in the Laparoscopic group were significantly higher thanthose in the Open Group on the 2nd postoperative day (P＜0.05), and the levels of the fourproteins in the Laparoscopic Group were significantly higher than those in the OpenGroup on the 3rd postoperative day (P＜0.01).Conclusions Laparoscopic-assisted resection of rectal carcinoma gives lower levelsof stress responses compared to open surgery, which benefits the restoration of energymetabolism and visceral proteins. However, both the laparoscopic and open operation can result in significant decrease in visceral proteins at early period postoperatively.