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术中低呼气末二氧化碳水平与择期结直肠癌手术后无复发生存率的改善相关
贵州医科大学 麻醉与心脏电生理课题组
翻译：黄祥 编辑：周倩 审校：曹莹
较高水平的二氧化碳增加了结肠癌细胞的体外侵袭能力。目前尚缺乏评估呼气末二氧化碳浓度(EtCO2)改善结直肠癌手术后结果的研究。因此，我们评估了术中EtCO2是否与择期结直肠癌（CRC）手术后无复发生存期相关。
方法
我们分析了2009年至2018年在海德堡大学医院接受择期结直肠癌切除术的528例患者。计算术中EtCO2平均值。该研究队列被分为低EtCO2组和高EtCO2组。主要结果是无复发生存期，直到最后一次已知的随访。各组比较采用Kaplan-Meier分析。协变量采用cox回归分析进行控制。脓毒症、再手术、手术部位感染、住院期间的心血管事件以及总生存率是次要结果。
结果
低EtCO2组的平均EtCO2为33.8mmHg±1.2，而高EtCO2组为37.3mmHg±1.6。中位随访时间为3.8(Q1-Q3，2.5-5.1）年。低EtCO2组的无复发生存率较高（log-rank检验：p=0.024）。校正混杂因素后，较低的EtCO2与无复发生存率增加相关（HR=1.138,95%-CI：1.015–1.276，p=0.027)；平均EtCO2每降低1mmHg，主要结局的风险降低12.1%。低EtCO2组的1年和5年生存率也更高。我们没有发现其他次要结果的差异。
结直肠癌手术中较低的EtCO2可能有利于肿瘤预后，应在确认性研究中进行评估。
原始文献：Dehne S,Kirschner L,Strowitzki MJ, et al. Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery. J Clin Anesth. 2024;96:111495.
Low intraoperative end-tidal carbon dioxide levels are associated with improved recurrence-free survival after elective colorectal cancer surgery
Abstract
BACKGROUND
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.
