Abstract
BACKGROUND: Older patients are prone to postoperative cognitive decline after laparoscopic rectal cancer surgery, which may be associated with increased intraoperative intracranial pressure (ICP). This study investigated the correlation between intraoperative ICP changes, as indicated by measurements of the optic nerve sheath diameter (ONSD) using ultrasonography, and subsequent cognitive function to provide better patient care. AIM: To evaluate changes in ICP and associated postoperative neurocognition in older adults after laparoscopic radical resection for rectal cancer. METHODS: We included 140 patients who visited the Mianyang Central Hospital for malignant rectal tumors, measured their ONSDs before surgery and 30 and 60 minutes after the Trendelenburg position during surgery, and evaluated the patients' cognitive function 1 day before surgery and 1, 4, and 7 days after surgery. The Mini-Mental State Examination (MMSE) and confusion assessment method (CAM) scores of the patients with different ONSDs were compared at different times after surgery. RESULTS: In patients with an ONSD greater than 5.00 mm (group A1), the MMSE scores at 1 day and 4 days after surgery were significantly lower than those of patients with an ONSD less than or equal to 4.00 mm (group A2) (P < 0.05). The CAM scores of group A1 were significantly higher than those of group A2 (P < 0.05). The MMSE scores of group A1 on days 1 and 4 after surgery were significantly lower than those 1 day before and 7 days after surgery (P < 0.05), while the CAM scores 1 day and 4 days after surgery were significantly higher than those 1 day before and 7 days after surgery. CONCLUSION: Decline in cognitive function among older adults after the procedure may be related to intracranial hypertension during surgery.