Effects of Perioperative Circulating Adiponectin Levels on Postoperative Systemic Inflammatory Response in Patients Undergoing Major Colorectal Surgery

Gastrointestinal tumors are commonly presented for surgical resections. According to Global Cancer Statistics 2020: GLOBOCAN estimates colorectal carcinoma ranks third in terms of incidence, but second in terms of mortality for overall carcinomas worldwide. At the same time, obesity is a fast growing disease with of pandemic proportions with a current global prevalence of 39% according to the World Health Organisation (WHO). Many patients presented for major abdominal resections of colrectal carcinomas are obese. Obesity is chronic disease with complex pathophisiology. Adipose tissue besides being a storage site is responsible for secretion of various adipokines with imunometabolic role. Adipokines (also called adipocytokines) are cell-signaling molecules (cytokines) produced by the adipose tissue that play many functional roles in energy/metabolic status of the body, and inflammation. Among adipokines, adiponectin is predominantly antiinfflamatory adipokine which inhibits production of infflammatory citokines (IL-6) and is decreased in obesity. Adipocyte dysfunction in obesity with altered adipokines release results in chronic low-grade inflammatory state. Obesity is also well known risk factor for colorectal carcinoma in which oncogenesis adiponectin may be the important key according to recent findings.

Surgical stress after major colorectal surgery in perioperative period causes neuroendocrine, metabolic and imunologic changes in organism with production of proinfflamatory citokines and results with appearance of systemic infflammmatory response syndrome (SIRS). Dysregulated and overrated SIRS in early postoperative period can lead to complications with additional comorbidities, longer hospital stay and poorer outcome. A low grade chronic infflammatory state in obesity and colorectal carcinoma associated with potential hypoadiponectinemia can enable the cytokine storm and exaggerated /dysregulated SIRS in these patients after surgery. Due to this knowledge, it is logical to presume that adiponectin levels in perioperative period are associated with the intensity of systemic infflamatory response after major colorectal surgery.

Hypothesis: Perioperative blood adiponectin levels are associated with higher intensity of systemic infflamatory response in patients after major colorectal surgery.

Aim of this study is to:

1. Measure and investigate correlation between perioperative blood adiponectin levels and appearance and intensity of systemic infflamatory response in patients after major colorectal surgery.
2. Investigate correlation between perioperative blood adiponectin levels, SIRS and postoperative complications, days of ICU and lenght of hospital stay in patients presenting for major colrectal surgery.