Abstract
Background: Laparoscopic colorectal cancer surgery, while minimally invasive, induces systemic oxidative stress, inflammation, and immune dysfunction through surgical trauma and anesthesia-related stress. Esketamine, an NMDA receptor antagonist with antioxidant and anti-inflammatory properties, may mitigate these biochemical perturbations. This study evaluated esketamine’s effects on serum biomarkers of oxidative stress (glutathione, catalase, malondialdehyde, superoxide dismutase), inflammatory mediators (TNF-α, CRP, IL-6), and T lymphocyte subsets in patients undergoing laparoscopic colorectal cancer resection.
Methods: In this randomized controlled trial, 150 stage I-II colorectal cancer patients were allocated to esketamine (0.25 mg/kg bolus + 0.12 mg/kg/h infusion) or control (saline) groups during standardized anesthesia. Pre- and postoperative serum levels of oxidative stress markers (GSH, CAT, MDA, SOD), inflammatory cytokines (TNF-α, CRP, IL-6), and immune cell subsets (CD3+, CD4+, CD8+, CD4+/CD8+ ratio) were quantified via ELISA and flow cytometry. Statistical analysis compared intergroup differences using t-tests and chi-square tests.
Results: Postoperatively, the esketamine group exhibited significantly attenuated oxidative stress, with higher GSH (72.43 ± 6.63 vs. 60.16 ± 5.57 mg/mL, P < 0.05), CAT (92.56 ± 8.31 vs. 82.81 ± 7.75 U/mL), and SOD (84.53 ± 8.02 vs. 69.93 ± 7.05 nU/mL), alongside lower MDA (6.41 ± 0.52 vs. 9.52 ± 0.63 mmol/L). Pro-inflammatory cytokines were reduced (TNF-α: 40.32 ± 4.84 vs. 54.37 ± 5.80 pg/mL; IL-6: 50.83 ± 5.05 vs. 82.38 ± 8.46 pg/mL, P < 0.05). Immune function preservation was evident through elevated CD3+ (45.18 ± 5.01% vs. 37.05 ± 4.92%) and CD4+ T cells (26.51 ± 2.76% vs. 19.78 ± 2.09%), with a balanced CD4+/CD8+ ratio (1.12 ± 0.12 vs. 0.72 ± 0.09).
Conclusion: Esketamine-based anesthesia significantly ameliorates postoperative oxidative damage, suppresses inflammatory cytokine release, and preserves cellular immune homeostasis, as evidenced by targeted biochemical and immunological analyses. These findings highlight esketamine’s role in modulating perioperative biochemical pathways, potentially enhancing recovery in colorectal cancer surgery.
Keywords
Array
Array
Array
Array
Array
References
The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.