Risk Factors of Postoperative Cognitive Dysfunction (POCD) after Oncological Surgery-a systematic review

Risk Factors of Postoperative Cognitive Dysfunction (POCD) after Oncological Surgery-a systematic review
Hojjat Shadman Zahroodi,^1,* Afarin Rabbani,² Alireza Saadati,³ Parisa Gholambareshi,⁴
1. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
2. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
3. student research committee, Mashhad University of Medical Sciences, Mashhad , Iran
4. Faculty of Nutrition Sciences and Food Industry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Introduction: Introduction: Postoperative cognitive dysfunction (POCD) is a common morbidity usually after large and medium- sized surgery under general anesthesia and in elderly patients (in fact, it can occur in any ages). It affects many cognitive domains such as memory, information, concentration and attention. It impairs postoperative recovery, increase medical cost for patients, affect the quality of life of patients and also increase mortality. In most oncological cancers, long anesthesia duration, radical resections that cause serious traumas and also inflammatory responses that happens, increase this risk of POCD with high probability. The specific physiopathology and also really effective treatment of POCD are still unclear, so many studies should be done. Aim: In this review, we want to study risk factors of POCD in patients who had cancer and underwent surgery for it.
Methods: Methods and materials: A comprehensive search was done through all types of articles (except reviews and animal and cellular studies) in English in nine databases (PubMed, Google Scholar, Cochrane, Science Direct, Embace, Scopus, ISI, Web of Science and ProQuest) with the keywords of POCD, cancer and surgery and with the 10 years’ time filter. For the exclusion criteria study characteristics and report futures were considered. Review methods: All identified articles from different sources were transferred to a database using resource management software to remove duplicates. Two reviewers independently examined the titles and abstracts of the articles using the inclusion and exclusion criteria and checklist by Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) . In case of disagreement between the two, the judgment regarding the inclusion of the article in the study was applied with the opinion of a third reviewer.
Results: Results: As inclusion criteria 254 studies were involved that after omitting duplicates 173 studies were remained and by exclusion criteria 33 articles were selected as main studies of this systematic review. In our main studies, 3,884 patients were involved totally, and POCD cases were detected by tests like MMSE and TICS-M. Age, location and structural and biomolecular effects from the tumor, cancer-related anemia, anesthesia regimen, duration of anesthesia, type of anesthesia, perioperative cares and treatments, Inspiratory Muscle Training, mechanical ventilation, intraoperative blood loss , severity of surgery, the occurrence of complications, and pre-existing cognitive impairments, diabetes history, fasting over 3 days, a Systemic inflammatory response syndrome (SIRS) score of > 3 on the second day, Preoperative hyperhomocysteinemia, vitamin D deficiency, the levels of serum Tumor necrosis factor α(TNF-α), interleukin 6 (IL-6),IL-10, IL-1β, serum amyloid A (SAA), S100 calcium-binding protein β (S-100β), and high mobility group box-1 protein (HMGB-1) , C-reactive protein(CRP), Insulin-like growth factor 1 (IGF-1), Insulin Like Growth Factor Binding Protein 7(IGFBP7), miRNA-155, Phosphoinositide 3-kinases (PI3Ks) and Protein kinase B (AKT) after operation are some factors that affect the occurrence and intensity of POCD.
Conclusion: Conclusions: As the result, demographic factors, history of patient, anesthetic variables, location and structural and biomolecular effects from the neoplasms, perioperative and intraoperative cares and treatments, characteristics of surgery, biochemistry profile of patient’s serum are the factors relating to POCD. Science the exact physiopathology of POCD is unknown more cellular studies and comparative studies (between different procedures) are needed.
Keywords: pocd, postoperative cognitive dysfunction, cancer, oncology, surgery