Effect Of Different Periods Of Laparoscopic Radical Resection For Colorectal Cancer On Rehabilitation:Report Of 190 Cases

Objective:Through observing the convalescent differences of the patients with laparoscopic radical resection of colorectal cancer whose starting surgery times were at the day variance,coupled with a comprehensive analysis of the underlying reasons and exploring the risk factors of patients’postoperative complications,this study can find the objective evidence for the promoting rehabilitation.Methods:1.Through a retrospective analysis of a cohort study,clinical data of 190 patients who underwent laparoscopic radical surgery for colorectal cancer in our hospital from October2020 to September 2021 were reviewed.The patients were divided into two groups based on the start time of anesthesia and surgery:the morning（8:00-12:00）surgery group（n=98）and the afternoon（14:00-18:00）surgery group（n=92）.2.Firstly,the perioperative conditions of the two patient groups were analyzed,including the chief surgeon of performing the operation,dosage of sedative and analgesic anesthetics during surgery,operation time,anesthesia time,extubation time,intraoperative blood loss,postoperative first meal time,postoperative first exhaust and defecation time the incidence of complications,length of hospital stay and healthcare costs.3.Then we were compared between 2 groups,including preoperative and postoperative immune peripheral blood cells count,postoperative immune-inflammation indexes in order to analyze the impact of surgery time with day variance on inflammatory cells and postoperative inflammation indicators.Results:1.The number of patients with complications after surgery was lower in the afternoon surgical group（13/92 vs 27/98,P=0.023）,less dosage of anesthetic remifentanil（μg/kg/h）（6.22（4.82,8.04）vs 7.38（5.97,9.03）,P=0.001）,earlier extubation time（min）（12.00（5.00,32.50）vs 22.00（13.00,36.00）,P=0.003）and earlier postoperative first meal time of patients（hrs）（110.05（85.67,136.12）vs 137.99（91.57,162.66）,P=0.012）,compared with the morning surgery group.However,there was no significant difference in the chief surgeon of performing the operation,length of hospital stay and cost（P>0.05）and so on.2.Compared with the morning operation group,patients in the afternoon surgery group had a greater increase in postoperative white blood cell（WBC）(10⁹·L^-1)（（5.05±2.87）·vs（3.97±2.80）,P=0.009）and neutrophil（Neu）(10⁹·L^-1)（（6.01±2.89）·vs（4.63±2.72）,P=0.001）levels,and a greater decrease in postoperative lymphocyte（Lym）(10⁹·L^-1)（-0.92（-1.19,-0.61）vs-0.66·（-0.99,-0.44）,P<0.001）levels.Neutrophil to lymphocyte ratio（NLR）（15.58（11.14,22.33）vs 10.70（7.67,15.23）,P<0.001）,platelet to lymphocyte ratio（PLR）（330.80（222.73,479.43）vs 225.33（173.34,311.69）,P<0.001）and systemic immune inflammation index（SII）（3191.40（1846.72,5212.06）vs1939.70（1223.43,3119.61）,P<0.001）in the afternoon surgery group were significantly higher than those in the morning surgery group.Conclusion:1.Patients who received laparoscopic radical resection of colorectal cancer in the afternoon were more likely to have fewer postoperative complications,while having less dosage of anesthetic remifentanil during operation,earlier extubation time and earlier postoperative feeding,and better early recovery after operation.2.Patients undergoing laparoscopic radical resection for colorectal cancer in the afternoon showed a more intense acute inflammatory response represented by neutrophils,but perioperative infection-related complications did not increase.The impact on the long-term prognosis of these patients remains to be studied,and further follow-up will be conducted by the research team.