C-reactive protein as early predictor of complications after minimally invasive colorectal resection

Pedrazzani, Corrado; Moro, Michele; Mantovani, Guido Massimiliano; Lazzarini, Enrico; Conci, Simone; Ruzzenente, Andrea; Lippi, Giuseppe; Guglielmi, Alfredo

doi:10.1016/j.jss.2016.11.047

Cited by 18 publications

(25 citation statements)

References 29 publications

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“…Evaluation of ROC curves showed that the best sensitivity and specificity are achieved on POD3. The proposed cut-off values used in our research are much lower than previously mentioned in other studies involving open resections [ 27 , 29 ], but are similar to those performed on laparoscopic groups [ 30 , 31 ].…”

Section: Discussionmentioning

confidence: 50%

Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol.

Wierdak¹,

Pisarska²,

Kuśnierz-Cabała³

et al. 2018

Videosurgery and Other Miniinvasive Techniques

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IntroductionThanks to laparoscopy and enhanced recovery protocols (ERAS) it is possible to shorten hospitalization. Therefore, it seems reasonable to search for new early markers of infectious complications in order to select patients who are prone to development of complications.AimTo assess the usefulness of serum levels of C-reactive protein, interleukin-6 and procalcitonin as early indicators of infectious complications in patients after laparoscopic colorectal surgery with ERAS.Material and methodsThe prospective analysis included consecutive patients who underwent laparoscopic colorectal cancer resection. The following parameters were included in the analysis: C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin measured on postoperative days (PODs) 1, 2, 3. Patients were divided into two groups: uncomplicated (group 1) and complicated (group 2). The difference in levels of the markers and the dynamics of changes observed in both groups were analyzed.ResultsGroup 1 comprised 34 patients, and group 2 consisted of 17 patients. A significant increase of both absolute values and delta increments on all postoperative days was noted. ROC curve analysis showed that the best cut-off values indicating an infectious process were: CRP 129 mg/l on POD3 (92% sensitivity/80% specificity), IL-6 of 78 pg/ml on POD2 (91% sensitivity/97% specificity) and PCT 0.24 ng/ml on POD3 (93% sensitivity/68% specificity).ConclusionsOur study showed that regular measurement of all analyzed markers in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Further studies are needed to fully assess the role of routine biochemical measurements in the postoperative period after laparoscopic surgery with the ERAS protocol.

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Section: Discussionmentioning

confidence: 50%

Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol.

Wierdak¹,

Pisarska²,

Kuśnierz-Cabała³

et al. 2018

Videosurgery and Other Miniinvasive Techniques

View full text Add to dashboard Cite

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“…CRP levels re ect the intensity of an in ammatory reaction, and CRP also participates in activating the in ammatory cascade [8]. Recent studies have shown its e cacy for predicting postoperative complications, particularly in abdominal surgery [16,21].…”

Section: Discussionmentioning

confidence: 99%

“…However, in patients treated with CRS and HIPEC, the clinical detection of these complications is not always easy [13]. C-reactive protein (CRP) has been reported as a potential tool for predicting postoperative complications [14,15,16]. The normal level of CRP is less than 0.8 mg/L and varies beyond this limit during an in ammatory event.…”

Section: Introductionmentioning

confidence: 99%

Postoperative C-reactive protein kinetics predict postoperative complications in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis

Asmar

Bendavides

Moreau

et al. 2020

Preprint

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Background: Relatively high morbidity rates are reported after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). However, early predictors of complications after CRS plus HIPEC have not been identified. The aim of this study was to evaluate the predictive role of early postoperative serum C-reactive protein (CRP) level (Day 2-4) for the detection of post-operative complications.Patients and methods: We performed a retrospective study including 94 patients treated with complete CRS (R1) and HIPEC for PC from various primary origins (2011-2016). Post-operative complications were recorded. The values for postoperative inflammatory markers (white blood cells [WBC] and platelet counts, CRP) were compared between the different groups.Results: CRP on post-operative days 2-4 was significantly higher in patients with than without complications (124 mg/L vs 46 mg/L; p<0.0001) and higher in those with more major complications (162 mg/L vs 80 mg/L; p< 0.0012). WBC and platelet counts showed no difference within 5 days postoperatively.Conclusion: CRP levels, and kinetics mainly, between post-operative day 2 and 4, are decisive predictive markers of early and late post-operative complications after CRS plus HIPEC. The presence of post-operative complications should be suspected in patients with a high CRP mean, and a plateau level (days 2-4).

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“…Moreover, we identified that a postoperative change in the fibrinogen concentration > 20% was useful for predicting postoperative major complications following gynecologic laparoscopic surgeries. The role of acute-phase proteins in predicting the development of postoperative complications have been already investigated, but, to date, the majority of studies have focused on CRP [23][24][25][26][27][28][29][30][31][32].…”

Section: Discussionmentioning

confidence: 99%

The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study

et al. 2019

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Background: Complications after laparoscopic gynecological surgery may increase patients' morbidity and mortality; therefore, their timely diagnosis and early treatment would help clinicians to avoid life-threatening situations. We aimed to evaluate the predictive role of fibrinogen for diagnosing complications after laparoscopic gynecologic surgery for benign and malignant conditions. Patients and methods: All patients who underwent elective laparoscopic gynecologic surgery between June 2013 and December 2017 at the Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, were prospectively included. Post-operative complications were assessed and graded according to the Clavien-Dindo classification. Fibrinogen and white blood cell level were determined preoperatively, on the first post-operative day and at the appearance of symptoms indicative of an irregular post-operative course or at the time of rehospitalization for persistent symptoms. The postoperative changes (calculated from the first postoperative day) were correlated with the occurrence and severity of complications and their predictive role was assessed. Results: We enrolled 1016 patients: 36% underwent surgery for benign pathologies (mainly voluminous fibromatous uteri and severe deep endometriosis) and 64% for gynecologic malignancies. The overall complication rate was of 3.45%, the rate of major postoperative complications was 2.85%. A postoperative fibrinogen increase ≥ 20% had a high diagnostic accuracy to identify postoperative complications early (AUC 0.931, sensitivity 89%, and specificity 99%). The magnitude of postoperative fibrinogen change was associated with complication severity. Conclusions: Our findings demonstrated that fibrinogen increase can enable the early detection of postoperative complications after laparoscopic gynecological surgery. Further prospective and multi-center studies are warranted to confirm these results.

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C-reactive protein as early predictor of complications after minimally invasive colorectal resection

Cited by 18 publications

References 29 publications

Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol.

Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol.

Postoperative C-reactive protein kinetics predict postoperative complications in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis

The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study

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