Medicine (Austin & Northern Health) - Theses

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Type: Masters Research thesis × Author: Dean, Meara ×

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    The use of humidified, warmed CO2 in cancer surgery to improve patient outcomes
    Dean, Meara ( 2018)
    Aim To investigate the effects of warmed, humidified CO2 on peritoneal inflammation and tissue damage, tumor microenvironment, and perioperative outcomes in colorectal cancer surgery. Methods • A literature review was performed on peritoneum and mesocolon anatomy and physiology, the mechanisms of colorectal cancer recurrence, and the surgical techniques that are used to help reduce colorectal cancer recurrence. • A systematic review of the literature regarding warmed, humidified CO2 in abdominal surgery was performed. • A meta-analysis of the effects of warmed, humidified CO2 on peri-operative hypothermia was performed. • An experimental study was performed to investigate the effects of warmed, humidified CO2 on peritoneal inflammation and tissue damage, and colorectal cancer in a laparoscopic surgery mouse model. • A multi-centre, randomized, controlled trial was designed, evaluating the effect of warmed, humidified CO2 on peritoneal inflammation and tissue damage as a primary outcome, and secondary outcomes of systemic inflammation, presence of systemic ctDNA, perioperative hypothermia, length of stay, cost of intervention and quality of recovery. Findings A review of the literature reveals the use of warmed, humidified CO2 for insufflation during abdominal surgery may have potential benefits for patient care. However, findings are limited by the size and quality of published studies. Meta-analysis of published studies suggests a benefit in maintaining perioperative normothermia. The results of the experimental study show the use of warmed, humidified CO2 alters the tumor microenvironment. A multicentre, randomized, controlled, clinical study has been designed to further assess the effects on peritoneal inflammation, tissue damage and other perioperative outcomes. Conclusions The use of warmed, humidified CO2 in abdominal surgery has several potential benefits including reduced peritoneal structural damage and inflammation, maintenance of perioperative normothermia and reduced postoperative pain. The findings of this experimental study have shown an effect on the tumor microenvironment. Future research should re-assess this effect in human subjects. An adequately powered, multicentre, randomized, controlled clinical trial that has been implemented will help confirm the other effects of this therapy.