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Surgical Endoscopy

Published in:

01-01-2017

C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer

Authors: Eun Young Kim, Hyun Woo Yim, Cho Hyun Park, Kyo Young Song

Published in: Surgical Endoscopy | Issue 1/2017

Abstract

Background

The clinical outcomes for postoperative complications (PCs) after gastrectomy depend on early diagnosis and intensive treatment. The aim of this study was to investigate the role of C-reactive protein (CRP) as an early predictor of PCs after gastrectomy for gastric cancer.

Methods

A total of 334 consecutive patients who underwent gastrectomy for gastric cancer in 2014 were enrolled in this study. Blood samples were obtained preoperatively, and at postoperative days 1 and 4 for the measurement of inflammatory markers (white blood cell, neutrophil, and platelet counts, and CRP). Patients were classified into groups of major and minor/no PCs, which were defined as patients with PCs of more than grade III and those with grade I/II or without PCs, respectively, according to the Clavien–Dindo classification.

Results

Twenty-five patients developed major PCs. The CRP on postoperative day 4 provided superior diagnostic accuracy in predicting major PCs compared to the other systematic inflammatory markers. Multivariate analysis identified a CRP level of 16.8 mg/dl or greater on postoperative day 4 as a significant predictive factor for major PCs.

Conclusions

Among the various systemic inflammatory markers, CRP on postoperative day 4 is the most reliable predictor of PCs after gastrectomy for gastric cancer.

Kim KM, An JY, Kim HI, Cheong JH, Hyung WJ, Noh SH (2012) Major early complications following open, laparoscopic and robotic gastrectomy. Br J Surg 99:1681–1687CrossRefPubMed

Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, van Elk P, Obertop H, Gouma DJ, Taat CW et al (1995) Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet 345:745–748CrossRefPubMed

Cuschieri AFP, Fielding J, Craven J, Bancewicz J, Joypaul V, Cook P (1996) Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. The Surgical Cooperative Group. Lancet 347:995–999CrossRefPubMed

Sano T, Sasako M, Yamamoto S, Nashimoto A, Kurita A, Hiratsuka M, Tsujinaka T, Kinoshita T, Arai K, Yamamura Y, Okajima K (2004) Gastric cancer surgery: morbidity and mortality results from a prospective randomized controlled trial comparing D2 and extended para-aortic lymphadenectomy—Japan Clinical Oncology Group study 9501. J Clin Oncol 22:2767–2773CrossRefPubMed

Degiuli M, Sasako M, Calgaro M, Garino M, Rebecchi F, Mineccia M, Scaglione D, Andreone D, Ponti A, Calvo F (2004) Morbidity and mortality after D1 and D2 gastrectomy for cancer: interim analysis of the Italian Gastric Cancer Study Group (IGCSG) randomised surgical trial. Eur J Surg Oncol 30:303–308CrossRefPubMed

Jeong O, Kyu Park Y, Ran Jung M, Yeop Ryu S (2015) Analysis of 30-day postdischarge morbidity and readmission after radical gastrectomy for gastric carcinoma: a single-center study of 2107 patients with prospective data. Medicine (Baltimore) 94:e259CrossRef

Kim MC, Kim W, Kim HH, Ryu SW, Ryu SY, Song KY, Lee HJ, Cho GS, Han SU, Hyung WJ (2008) Risk factors associated with complication following laparoscopy-assisted gastrectomy for gastric cancer: a large-scale korean multicenter study. Ann Surg Oncol 15:2692–2700CrossRefPubMed

Inokuchi M, Kato K, Sugita H, Otsuki S, Kojima K (2014) Impact of comorbidities on postoperative complications in patients undergoing laparoscopy-assisted gastrectomy for gastric cancer. BMC Surg 14:97CrossRefPubMedPubMedCentral

Kim W, Song KY, Lee HJ, Han SU, Hyung WJ, Cho GS (2008) The impact of comorbidity on surgical outcomes in laparoscopy-assisted distal gastrectomy: a retrospective analysis of multicenter results. Ann Surg 248:793–799CrossRefPubMed

10.

Jeong SH, Ahn HS, Yoo MW, Cho JJ, Lee HJ, Kim HH, Lee KU, Yang HK (2010) Increased morbidity rates in patients with heart disease or chronic liver disease following radical gastric surgery. J Surg Oncol 101:200–204PubMed

11.

Shimizu T, Ishizuka M, Kubota K (2015) The preoperative serum C-reactive protein level is a useful predictor of surgical site infections in patients undergoing appendectomy. Surg Today 45:1404–1410CrossRefPubMed

12.

Kassir R, Blanc P, Bruna Tibalbo LM, Breton C, Lointier P (2015) C-Reactive protein and procalcitonin for the early detection of postoperative complications after sleeve gastrectomy: preliminary study in 97 patients. Surg Endosc 29:1439–1444CrossRefPubMed

13.

McSorley ST, Ramanathan ML, Horgan PG, McMillan DC (2015) Postoperative C-reactive protein measurement predicts the severity of complications following surgery for colorectal cancer. Int J Colorectal Dis 30:913–917CrossRefPubMed

14.

Selby J, Prabhudesai A (2014) Can C-reactive protein predict the severity of a post-operative complication after elective resection of colorectal cancer? Int J Colorectal Dis 29:1211–1215CrossRefPubMed

15.

Jing X, Huang C, Zhou H, Li C, Fan L, Chen J, Zhang G, Liu Y, Cui Z, Qi D, Ma J (2015) Association between serum C-reactive protein value and prognosis of patients with non-small cell lung cancer: a meta-analysis. Int J Clin Exp Med 8:10633–10639PubMedPubMedCentral

16.

Shishido Y, Fujitani K, Yamamoto K, Hirao M, Tsujinaka T, Sekimoto M (2016) C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection. Gastric Cancer 19:293–301CrossRefPubMed

17.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M (2005) Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138:8–13CrossRefPubMed

18.

Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, de Santibanes E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196CrossRefPubMed

19.

Adamina M, Steffen T, Tarantino I, Beutner U, Schmied BM, Warschkow R (2015) Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg 102:590–598CrossRefPubMed

20.

Ilhan N, Ilhan N, Ilhan Y, Akbulut H, Kucuksu M (2004) C-reactive protein, procalcitonin, interleukin-6, vascular endothelial growth factor and oxidative metabolites in diagnosis of infection and staging in patients with gastric cancer. World J Gastroenterol 10:1115–1120PubMedPubMedCentral

21.

Szczepanik AM, Scislo L, Scully T, Walewska E, Siedlar M, Kolodziejczyk P, Lenart M, Rutkowska M, Galas A, Czupryna A, Kulig J (2011) IL-6 serum levels predict postoperative morbidity in gastric cancer patients. Gastric Cancer 14:266–273CrossRefPubMedPubMedCentral

22.

Montagnana M, Minicozzi AM, Salvagno GL, Danese E, Cordiano C, De Manzoni G, Guidi GC, Lippi G (2009) Postoperative variation of C-reactive protein and procalcitonin in patients with gastrointestinal cancer. Clin Lab 55:187–192PubMed

23.

Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M (2013) Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol 20:1575–1583CrossRefPubMed

24.

Yoo HM, Lee HH, Shim JH, Jeon HM, Park CH, Song KY (2011) Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol 104:734–740CrossRefPubMed

25.

Tillett WS, Francis T (1930) Serological reactions in pneumonia with a non-protein somatic fraction of pneumococcus. J Exp Med 52:561–571CrossRefPubMedPubMedCentral

26.

Vermeire S, Van Assche G, Rutgeerts P (2005) The role of C-reactive protein as an inflammatory marker in gastrointestinal diseases. Nat Clin Pract Gastroenterol Hepatol 2:580–586CrossRefPubMed

27.

Allin KH, Nordestgaard BG (2011) Elevated C-reactive protein in the diagnosis, prognosis, and cause of cancer. Crit Rev Clin Lab Sci 48:155–170CrossRefPubMed

28.

Silvestre J, Rebanda J, Lourenco C, Povoa P (2014) Diagnostic accuracy of C-reactive protein and procalcitonin in the early detection of infection after elective colorectal surgery—a pilot study. BMC Infect Dis 14:444CrossRefPubMedPubMedCentral

29.

Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, McMillan DC (2012) C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol 19:4168–4177CrossRefPubMed

30.

Frongia G, Mehrabi A, Ziebell L, Schenk JP, Gunther P (2016) Predicting postoperative complications after pediatric perforated appendicitis. J Invest Surg 29:185–194CrossRef

31.

Hoeboer SH, Groeneveld AB, Engels N, van Genderen M, Wijnhoven BP, van Bommel J (2015) Rising C-reactive protein and procalcitonin levels precede early complications after esophagectomy. J Gastrointest Surg 19:613–624CrossRefPubMedPubMedCentral

32.

Watt DG, Horgan PG, McMillan DC (2015) Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery 157:362–380CrossRefPubMed

33.

Ramanathan ML, MacKay G, Platt J, Horgan PG, McMillan DC (2015) The impact of open versus laparoscopic resection for colon cancer on C-reactive protein concentrations as a predictor of postoperative infective complications. Ann Surg Oncol 22:938–943CrossRefPubMed

34.

Eom BW, Joo J, Kim YW, Park B, Yoon HM, Ryu KW, Kim SJ (2015) Nomogram estimating the probability of intraabdominal abscesses after gastrectomy in patients with gastric cancer. J Gastric Cancer 15:262–269CrossRefPubMedPubMedCentral

35.

Strong VE, Song KY, Park CH, Jacks LM, Gonen M, Shah M, Coit DG, Brennan MF (2010) Comparison of gastric cancer survival following R0 resection in the United States and Korea using an internationally validated nomogram. Ann Surg 251:640–646CrossRefPubMed

Title: C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer
Authors: Eun Young Kim
Hyun Woo Yim
Cho Hyun Park
Kyo Young Song
Publication date: 01-01-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 1/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5272-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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