An: 2011, Nr.4, Articol Nr. 19

Title: 

Authors: 

      ORGANS AND SYSTEMS INVOLVED IN SURGICAL STRESS RESPONSE IN MAJOR NEOPLASTIC SURGERY (Abstract): According to World Health Organisation, cancer is the leading cause of death into the world. Surgery remains one important branch of medicine that deals with diagnosis, staging and treatment of cancer by manual and instrumental means. Surgical trauma, the neoplastic diseases, comorbidities and medications can potentially trigger the state of physiological stress response, characterized by changes in haemodynamics, endocrine and immune functions, whose final purpose is preservation of homeostasis and survival. This reactions implies a complex activation and interactions between autonomic nervous system, hypothalamic pituitary axis and the autocrine system of acute phase proteins and inflammatory cytokines. Generally, the magnitude of the metabolic response is proportional to the severity of the surgical trauma and de degree of tumoral invasion. The final result is substrat mobilization, muscle protein loss and sodium and water retention, with suppression of anabolic hormones secretion. These changes have probably evolved to aid survival in a more primitive environement by mobilizing substrat, limiting tissue damage, destroying infectious organisms and activating physiological events. The benefits of the stress response are not obvious in modern medicine, when physiological changes can be more easily corrected and it may even have detrimental effects. In recent years, research has focused on discovering all the components of surgical stress response and on methods to modify the response associated to surgery, in an attempt to improve patient outcome.

Key words: SURGERY, HORMONAL RESPONSE, CORTISOL, SYMPATHETIC NERVOUS SYSTEM, CATHECOLAMINES, CYTOKINES