Diagnostic study and meta-analysis of C-reactive protein as a predictor of postoperative inflammatory complications after gastroesophageal cancer surgery

Abstract

There is limited evidence for the diagnostic accuracy of CRP levels for PIC after gastroesophageal cancer surgery. CRP levels on POD 4 might be useful to rule out PIC, but its diagnostic accuracy is moderate at best. For clinical routine use CRP levels are clearly not sufficient to predict PIC and have to be interpreted in the context of the whole clinical picture.

C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection

“…Interestingly, however, those two studies [19,31] were similar to our own in terms of the CRP cutoff value identified as the best predictor of postoperative infectious complications, which suggests that optimal predictive value of CRP was only minimally affected by differing amounts of surgical stress and varying incidences of postoperative morbidity in relation to the specific lesions being treated.…”

“…Additionally, the sample size of the present study, at 417 patients, is currently the largest in the literature on esophagogastric cancer surgery [19,31], as shown in Table 3.…”

“…With regard to the diagnostic value of postoperative CRP concentrations in predicting infectious complications, particularly after gastric cancer resection, there has been no report focusing on patients after gastric cancer resection, though there are limited reports with relatively small sample sizes of 136-210 patients [19,31] relating to gastroesophageal junction cancer as well as gastric cancer. Additionally, the sample size of the present study, at 417 patients, is currently the largest in the literature on esophagogastric cancer surgery [19,31], as shown in Table 3.…”

“…There are several biochemical markers of the acute systemic inflammatory response, including CRP and WBC, and several recent studies have suggested a possible role for CRP in predicting the likelihood of infectious complications after gastrointestinal cancer surgery [19,[25][26][27][28][29][30][31], as shown in Table 3. These studies have proposed that an abnormally elevated CRP level on POD 3 or 4 or persistent elevation of CRP may be a useful predictor of infectious complications.…”

“…Although D2 gastrectomy is now recommended as the standard surgical procedure for patients with resectable gastric cancer in Europe [32,33] and the United States [34], as well as in East Asia [35], various degrees of lymphadenectomy were performed in previous Western studies [19,31] investigating CRP values following esophagogastric cancer surgery. Interestingly, however, those two studies [19,31] were similar to our own in terms of the CRP cutoff value identified as the best predictor of postoperative infectious complications, which suggests that optimal predictive value of CRP was only minimally affected by differing amounts of surgical stress and varying incidences of postoperative morbidity in relation to the specific lesions being treated.…”