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Tsukimoto S, Kitaura A, Kuroda H, Imaizumi U, Yoshino F, Yoshida A, Nakao S, Ohta N, Nakajima Y, Sanuki T. Anti-inflammatory potential of remimazolam: A laboratory and clinical investigation. Immun Inflamm Dis 2024; 12:e1218. [PMID: 38483030 PMCID: PMC10938462 DOI: 10.1002/iid3.1218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/24/2024] [Accepted: 03/03/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Anesthetic agents, particularly intravenous anesthetics, may affect immune function and tumorigenic factors. We herein investigated whether the anti-inflammatory effects of anesthetic agents are attributed to their antioxidant properties. The antioxidant and anti-inflammatory effects of remimazolam, a new anesthetic, remain unclear. We hypothesized that remimazolam exerts anti-inflammatory effects due to its antioxidant properties, which may affect the postoperative inflammatory response. This retrospective clinical study examined this hypothesis using laboratory and clinical approaches. METHODS The antioxidant effects of remimazolam and dexmedetomidine were assessed by electron spin resonance (ESR) spectroscopy, and postoperative inflammatory responses were compared in 143 patients who underwent transcatheter aortic valve replacement at Kindai University Hospital between April 2021 and December 2022. The primary endpoint was the presence or absence of the antioxidant effects of the anesthetics themselves using ESR. RESULTS Remimazolam at clinical concentrations exerted antioxidant effects, whereas dexmedetomidine did not. Increases in C-reactive protein (CRP) levels on POD3 from preoperative values were significantly smaller in the remimazolam group than in the dexmedetomidine group (1.33 ± 1.29 vs. 2.17 ± 1.84, p = .014). CONCLUSIONS Remimazolam exerted stronger anti-inflammatory effects than dexmedetomidine, and these effects were enhanced by its antioxidant properties, which may have affected postoperative CRP production.
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Affiliation(s)
- Shota Tsukimoto
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Atsuhiro Kitaura
- Department of AnesthesiologyKindai University Faculty of MedicineOsakasayamaOsakaJapan
| | - Hidetaka Kuroda
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Uno Imaizumi
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Fumihiko Yoshino
- Department of PharmacologyKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Ayaka Yoshida
- Department of Dental EducationKanagawa Dental UniversityYokosukaKanagawaJapan
| | - Shinchi Nakao
- Perioperative Management CenterOkanami General HospitalIgaMieJapan
| | - Noriyuki Ohta
- Department of AnesthesiologyKindai University Faculty of MedicineOsakasayamaOsakaJapan
| | - Yasuhumi Nakajima
- Department of AnesthesiologyKindai University Faculty of MedicineOsakasayamaOsakaJapan
| | - Takuro Sanuki
- Department of Dental AnesthesiologyKanagawa Dental UniversityYokosukaKanagawaJapan
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2
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Chen M, Ye F, Huang P, Liang Z, Liu H, Zheng X, Li W, Luo S, Kang L, Huang L. Inflammatory stress response after transanal vs laparoscopic total mesorectal excision: a cohort study based on the TaLaR trial. Int J Surg 2024; 110:151-158. [PMID: 37916926 PMCID: PMC10793793 DOI: 10.1097/js9.0000000000000838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/28/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Transanal total mesorectal excision (taTME) is a novel approach to radical surgery for low rectal cancer; however, it is not clear whether taTME causes a more severe inflammatory stress response than laparoscopic total mesorectal excision (laTME). Therefore, the authors conducted this study to address this question, with the secondary objective of analyzing the predictive effect of inflammatory indexes on postoperative infective complications between laTME and taTME. METHODS A total of 545 cases of laTME and 544 cases of taTME from the TaLaR randomized controlled trial were included. Inflammatory stress response was assessed via C-reactive protein (CRP), white blood cell count, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, and prognostic nutritional index. Inflammatory indexes were measured and calculated preoperatively (t1) and on postoperative days one (t2) and seven (t3). The accuracy of inflammatory indexes as predictor of infective complications was evaluated by areas under the receiver operating characteristic curve. RESULTS Preoperative blood parameters were comparable between the two surgical methods. There were no significant differences in CRP, white blood cell count, neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio, or prognostic nutritional index between the two surgical methods at any time point ( P >0.05). Among the inflammatory indexes at three time points, CRP on the first postoperative day was the most accurate predictor of infective complications, which is suitable for two surgical methods. The AUC was 0.7671 ( P <0.0001) with a cutoff of 39.84 mg/l, yielding 94% sensitivity and 47% specificity. CONCLUSIONS Compared with laTME, taTME surgery has no obvious disadvantage with respect to the postoperative inflammatory stress response. In addition, inflammatory indexes were favorable in predicting infective complications, with the best results for CRP on the first postoperative day. Defining the specific predictors for laTME and taTME is unnecessary.
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Affiliation(s)
- Mian Chen
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Fujin Ye
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Pinzhu Huang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Zhenxing Liang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Huashan Liu
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Xiaobin Zheng
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Wenxin Li
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Shuangling Luo
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Liang Kang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
| | - Liang Huang
- Department of General Surgery (Colorectal Surgery)
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases, The Sixth Affiliated Hospital, Sun Yat-sen University
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Tian BWCA, Agnoletti V, Ansaloni L, Coccolini F, Bravi F, Sartelli M, Vallicelli C, Catena F. Management of Intra-Abdominal Infections: The Role of Procalcitonin. Antibiotics (Basel) 2023; 12:1406. [PMID: 37760703 PMCID: PMC10525176 DOI: 10.3390/antibiotics12091406] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/20/2023] [Accepted: 08/30/2023] [Indexed: 09/29/2023] Open
Abstract
Patients with intra-abdominal sepsis suffer from significant mortality and morbidity. The main pillars of treatment for intra-abdominal infections are (1) source control and (2) early delivery of antibiotics. Antibiotic therapy should be started as soon as possible. However, the duration of antibiotics remains a matter of debate. Prolonged antibiotic delivery can lead to increased microbial resistance and the development of nosocomial infections. There has been much research on biomarkers and their ability to aid the decision on when to stop antibiotics. Some of these biomarkers include interleukins, C-reactive protein (CRP) and procalcitonin (PCT). PCT's value as a biomarker has been a focus area of research in recent years. Most studies use either a cut-off value of 0.50 ng/mL or an >80% reduction in PCT levels to determine when to stop antibiotics. This paper performs a literature review and provides a synthesized up-to-date global overview on the value of PCT in managing intra-abdominal infections.
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Affiliation(s)
- Brian W. C. A. Tian
- Department of General Surgery, Singapore General Hospital, Outram Road, Singapore 169608, Singapore;
| | - Vanni Agnoletti
- Anesthesia and Intensive Care Unit, M. Bufalini Hospital, 47521 Cesena, Italy
| | - Luca Ansaloni
- Department of Surgery, Pavia University Hospital, 27100 Pavia, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Surgery Department, Pisa University Hospital, 56126 Pisa, Italy
| | | | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Carlo Vallicelli
- Department of Emergency and Trauma Surgery, M. Bufalini Hospital, 47521 Cesena, Italy
| | - Fausto Catena
- Department of Surgery, “Maurizio Bufalini” Hospital, 47521 Cesena, Italy
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4
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Correa Neto IJF, Nishiyama VKG, Theis C, Schelle G, Robles AG, Robles L. C-REACTIVE PROTEIN AS POSTOPERATIVE COMPLICATIONS PREDICTOR OF COLORECTAL SURGERIES. ARQUIVOS DE GASTROENTEROLOGIA 2023; 60:4-10. [PMID: 37194779 DOI: 10.1590/s0004-2803.202301000-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/19/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND The use of inflammatory markers in order to accurate the diagnosis, decrease the reoperation rate and enable earlier interventions during the postoperative period of a colorectal surgery is increasingly necessary, with the purpose of reducing morbimortality, nosocomial infections, costs and time of a readmission. OBJECTIVE To analyze C-reactive protein level on the third postoperative day of an elective colorectal surgery and compare the marks between reoperated and non-reoperated patients and to establish a cutoff value to predict or avoid surgical reoperations. METHODS Retrospective study based on the analysis of electronic charts of over 18-year-old patients who underwent an elective colorectal surgery with primary anastomoses during the period from January 2019 to May 2021 by the proctology team of Santa Marcelina Hospital Department of General Surgery with C-reactive protein (CRP) dosage taken on the third postoperative day. RESULTS We assessed 128 patients with a mean age of 59.22 years old and need of reoperation of 20.3% of patients, half of these due to dehiscence of colorectal anastomosis. Comparing CRP rates on the third postoperative day between non-reoperated and reoperated patients, it was noted that in the former group the average was of 153.8±76.2 mg/dL, whereas in reoperated patients it was 198.7±77.4 mg/dL (P<0.0001) and the best CRP cutoff value to predict or investigate reoperation risk was 184.8 mg/L with an accuracy of 68% and negative predictive value of 87.6%. CONCLUSION CRP levels assessed on the third postoperative day of elective colorectal surgery were higher in patients who were reoperated and the cutoff value for intra-abdominal complication of 184.8mg/L presented a high negative predictive value.
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Affiliation(s)
| | | | - Cláudia Theis
- Hospital Santa Marcelina, Departamento Cirurgia Geral, Serviço de Coloproctologia, São Paulo, SP, Brasil
| | - Gabriela Schelle
- Hospital Santa Marcelina, Departamento Cirurgia Geral, Serviço de Coloproctologia, São Paulo, SP, Brasil
| | | | - Laercio Robles
- Hospital Santa Marcelina, Departamento Cirurgia Geral, Serviço de Coloproctologia, São Paulo, SP, Brasil
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Brinkman DJ, Gupta I, Matteucci PB, Ouchouche S, de Jonge WJ, Coatney RW, Salam T, Chew DJ, Irwin E, Yazicioglu RF, Nieuwenhuizen GAP, Vervoordeldonk MJ, Luyer MDP. Splenic arterial neurovascular bundle stimulation in esophagectomy: A feasibility and safety prospective cohort study. Front Neurosci 2022; 16:1088628. [PMID: 36620453 PMCID: PMC9817142 DOI: 10.3389/fnins.2022.1088628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The autonomic nervous system is a key regulator of inflammation. Electrical stimulation of the vagus nerve has been shown to have some preclinical efficacy. However, only a few clinical studies have been reported to treat inflammatory diseases. The present study evaluates, for the first time, neuromodulation of the splenic arterial neurovascular bundle (SpA NVB) in patients undergoing minimally invasive esophagectomy (MIE), in which the SpA NVB is exposed as part of the procedure. Methods This single-center, single-arm study enrolled 13 patients undergoing MIE. During the abdominal phase of the MIE, a novel cuff was placed around the SpA NVB, and stimulation was applied. The primary endpoint was the feasibility and safety of cuff application and removal. A secondary endpoint included the impact of stimulation on SpA blood flow changes during the stimulation, and an exploratory point was C-reactive protein (CRP) levels on postoperative day (POD) 2 and 3. Results All patients successfully underwent placement, stimulation, and removal of the cuff on the SpA NVB with no adverse events related to the investigational procedure. Stimulation was associated with an overall reduction in splenic arterial blood flow but not with changes in blood pressure or heart rate. When compared to historic Propensity Score Matched (PSM) controls, CRP levels on POD2 (124 vs. 197 mg/ml, p = 0.032) and POD3 (151 vs. 221 mg/ml, p = 0.033) were lower in patients receiving stimulation. Conclusion This first-in-human study demonstrated for the first time that applying a cuff around the SpA NVB and subsequent stimulation is safe, feasible, and may have an effect on the postoperative inflammatory response following MIE. These findings suggest that SpA NVB stimulation may offer a new method for immunomodulatory therapy in acute or chronic inflammatory conditions.
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Affiliation(s)
- David J. Brinkman
- Department of Surgery, Catharina Hospital, Eindhoven, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Isha Gupta
- Galvani Bioelectronics, Stevenage, United Kingdom
| | | | | | - Wouter J. de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | | | | | - Eric Irwin
- Galvani Bioelectronics, Stevenage, United Kingdom
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6
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de Ponthaud C, Guyard C, Blondeau M, Giacca M, Monsinjon M, Frontali A, Panis Y. Systematic C-reactive protein monitoring reduces hospital stay after laparoscopic ileal pouch-anal anastomosis. A comparative study of 158 consecutive patients with ulcerative colitis. Colorectal Dis 2022; 24:1543-1549. [PMID: 35778869 DOI: 10.1111/codi.16246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 06/18/2022] [Accepted: 06/23/2022] [Indexed: 01/07/2023]
Abstract
AIM C-reactive protein (CRP) is a common biomarker of inflammation which has largely been used to predict the risk of postoperative septic complications after colorectal surgery. However, no data exist concerning its potential benefit after ileal pouch-anal anastomosis (IPAA) for ulcerative colitis (UC). The aim of this study was to evaluate a CRP-driven monitoring discharge strategy after laparoscopic IPAA for UC. METHODS Since 2012, 158 patients undergoing a laparoscopic IPAA for UC have been included: 66 patients (CRP group) operated since 2016 had a CRP-driven monitoring discharge on postoperative day 5 (POD 5) and were discharged on POD 6 if CRP < 100 mg/L; these patients were matched (according to age, gender, body mass index, IPAA in two or three steps) to 92 patients operated between 2012 and 2016 without any CRP monitoring (control group). RESULTS Median length of hospital stay was shorter in the CRP than the control group (7 vs. 9 days; P < 0.001) and discharge on POD 6 occurred more frequently in the CRP group (47% vs. 7%, P < 0.001). No difference was observed between the two groups concerning overall morbidity (P = 0.980), surgical site infection (P = 0.554), Clavien-Dindo ≥ IIIa morbidity (P = 0.523), unplanned rehospitalization (P = 0.734) and 30-day reoperation (P = 0.240). CONCLUSION CRP-driven monitoring discharge strategy after laparoscopic IPAA for UC is associated with a significant reduction in length of hospital stay, without increasing morbidity, reoperation or rehospitalization rates.
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Affiliation(s)
- Charles de Ponthaud
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Clémence Guyard
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Marc Blondeau
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Massimo Giacca
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Marie Monsinjon
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Alice Frontali
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
| | - Yves Panis
- Department of Colorectal Surgery, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris and Université of Paris, Clichy, France
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7
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Anthis AHC, Abundo MP, Neuer AL, Tsolaki E, Rosendorf J, Rduch T, Starsich FHL, Weisse B, Liska V, Schlegel AA, Shapiro MG, Herrmann IK. Modular stimuli-responsive hydrogel sealants for early gastrointestinal leak detection and containment. Nat Commun 2022; 13:7311. [PMID: 36437258 PMCID: PMC9701692 DOI: 10.1038/s41467-022-34272-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 10/19/2022] [Indexed: 11/28/2022] Open
Abstract
Millions of patients every year undergo gastrointestinal surgery. While often lifesaving, sutured and stapled reconnections leak in around 10% of cases. Currently, surgeons rely on the monitoring of surrogate markers and clinical symptoms, which often lack sensitivity and specificity, hence only offering late-stage detection of fully developed leaks. Here, we present a holistic solution in the form of a modular, intelligent suture support sealant patch capable of containing and detecting leaks early. The pH and/or enzyme-responsive triggerable sensing elements can be read out by point-of-need ultrasound imaging. We demonstrate reliable detection of the breaching of sutures, in as little as 3 hours in intestinal leak scenarios and 15 minutes in gastric leak conditions. This technology paves the way for next-generation suture support materials that seal and offer disambiguation in cases of anastomotic leaks based on point-of-need monitoring, without reliance on complex electronics or bulky (bio)electronic implantables.
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Affiliation(s)
- Alexandre H C Anthis
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, CH-8092, Zurich, Switzerland
- Laboratory for Particles Biology Interactions, Department Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, CH-9014, St. Gallen, Switzerland
| | - Maria Paulene Abundo
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
| | - Anna L Neuer
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, CH-8092, Zurich, Switzerland
- Laboratory for Particles Biology Interactions, Department Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, CH-9014, St. Gallen, Switzerland
| | - Elena Tsolaki
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, CH-8092, Zurich, Switzerland
- Laboratory for Particles Biology Interactions, Department Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, CH-9014, St. Gallen, Switzerland
| | - Jachym Rosendorf
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Thomas Rduch
- Laboratory for Particles Biology Interactions, Department Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, CH-9014, St. Gallen, Switzerland
- Department of Gynaecology, Cantonal Hospital St Gallen (KSSG), Rorschacherstrasse 95, CH-9007, St Gallen, Switzerland
| | - Fabian H L Starsich
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, CH-8092, Zurich, Switzerland
- Laboratory for Particles Biology Interactions, Department Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, CH-9014, St. Gallen, Switzerland
| | - Bernhard Weisse
- Laboratory for Mechanical Systems Engineering, Department of Engineering Sciences, Empa - Swiss Laboratories for Materials Science and Technology, Ueberlandstrasse 129, CH-8600, Dübendorf, Switzerland
| | - Vaclav Liska
- Department of Surgery, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, Prague, Czech Republic
| | - Andrea A Schlegel
- Department of Visceral Surgery and Transplantation, University Hospital Zurich, CH-8091, Zurich, Switzerland
- Swiss HPB and Transplant Center, Zurich, Rämistrasse 100, CH-8091, Zurich, Switzerland
- Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Centre of Preclinical Research, Milan, 20122, Italy
| | - Mikhail G Shapiro
- Division of Chemistry and Chemical Engineering, California Institute of Technology, Pasadena, CA, 91125, USA
- Howard Hughes Medical Institute, Pasadena, CA, 91125, USA
| | - Inge K Herrmann
- Nanoparticle Systems Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Sonneggstrasse 3, CH-8092, Zurich, Switzerland.
- Laboratory for Particles Biology Interactions, Department Materials Meet Life, Swiss Federal Laboratories for Materials Science and Technology (Empa), Lerchenfeldstrasse 5, CH-9014, St. Gallen, Switzerland.
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8
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Gozalichvili D, Binquet C, Boisson C, Guiraud A, Facy O, Ortega-Deballon P. Early detection of anastomotic leak with C-reactive protein increases the chances of anastomotic salvage. Colorectal Dis 2022; 25:728-737. [PMID: 36323646 DOI: 10.1111/codi.16399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 09/16/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
AIM Anastomotic leak results in increased morbidity and affects functional and oncological outcomes after colectomy. Measurement of C-reactive protein (CRP) allows early detection of anastomotic leaks. The aim of this study was to evaluate the benefit to the patient of earlier diagnosis and management of anastomotic leaks, namely avoiding takedown of the anastomosis. METHOD Patients with an anastomotic fistula after elective colorectal surgery from 2010 to 2020 were included. Three periods were defined according to progressive adherence to the CRP protocol in our department. A comparison was made between the periods 'before' (2010-2013) and 'after' (2016-2020) in terms of morbidity, mortality, anastomotic salvage, days spent in hospital within the first postoperative month, timely adjuvant chemotherapy and anastomotic stenosis. RESULTS Out of 2655 elective colorectal operations, 171 patients presented with an anastomotic leak and 123 patients were included in the study. In univariate analysis, patients in the 'after' group had fewer severe complications (Clavien-Dindo Grade III to IV, 66.7% vs. 56.9; p = 0.017); the difference did not reach significance regarding timely postoperative chemotherapy (p = 0.058) and anastomotic stenosis (p = 0.682). In both, univariate and multivariate analysis, the 'after' period increased the chances of preserving the anastomosis (OR = 2.37 [1.08-5.17]) and increased the number of days out of hospital (p = 0.0002). CONCLUSION A CRP-based protocol for the screening of anastomotic leaks after colorectal surgery was related to increased anastomotic conservation, a decreased impact and severity of the leak and a shorter length of hospital stay.
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Affiliation(s)
- David Gozalichvili
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - Christine Binquet
- INSERM, CIC1432, Dijon, France.,Clinical Investigation Centre, Dijon University Hospital, Dijon, France
| | - Cyril Boisson
- INSERM, CIC1432, Dijon, France.,Clinical Investigation Centre, Dijon University Hospital, Dijon, France
| | - Adeline Guiraud
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France
| | - Olivier Facy
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France.,INSERM UMR 1231, University of Bourgogne-Franche-Comté, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgery, Dijon University Hospital, Dijon, France.,INSERM, CIC1432, Dijon, France.,Clinical Investigation Centre, Dijon University Hospital, Dijon, France.,INSERM UMR 1231, University of Bourgogne-Franche-Comté, Dijon, France
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9
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Lazarus E, Jesudason MR, Varghese G, Raghunath R, Mittal R, Prakash JAJ. Association of a Single Post-Operative Day Three C-Reactive Protein Value with Anastomotic Complications after Colorectal Surgery: A Prospective Observational Study. Surg Infect (Larchmt) 2022; 23:576-582. [PMID: 35867007 DOI: 10.1089/sur.2022.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Early detection and treatment of a colorectal anastomotic leak reduces leak-associated morbidity. The primary objective of this study was to assess the role of C-reactive protein (CRP) as a tool to facilitate the early diagnosis of large bowel anastomotic leak. Patients and Methods: We conducted a prospective observational study at a specialized colorectal unit of a tertiary referral teaching center where we recorded CRP levels pre-operatively and on day three for 113 patients undergoing a large bowel anastomosis. The primary outcome measure was the occurrence of anastomotic leak and its association with post-operative day three CRP levels (day one considered as 24 hours after surgery). The area under the curve of the receiver operating characteristic (ROC) curve analysis for the day three CRP value with the anastomotic leak was calculated and optimal cutoffs derived. Definitions and diagnostic criteria for a leak were established before commencing the study. Demographic, operative, diagnostic, and interventional procedure data were also recorded. Results: Twenty-two patients had an anastomotic leak (19.4%), and 14 (12.3%) required re-exploration or drain placement. The cutoff value of day three CRP with the greatest area under the ROC curve in the ROC curve analysis was 166 mg/L (area under the curve [AUC], 0.853) for open and laparoscopic procedures (sensitivity and specificity of 81.81% and 82.42%, respectively) with a negative predictive value of 93.8%. There was no difference in mean day three CRP levels between open and laparoscopic surgery (116.57 mg/L vs. 108.94 mg/L) Conclusions: A CRP value of more than 166 mg/L on day three should raise suspicion of an anastomotic leak.
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Affiliation(s)
- Emmanuel Lazarus
- Department of Surgery Unit-2, Christian Medical College, Vellore, India
| | | | - Gigi Varghese
- Department of Surgery Unit-2, Christian Medical College, Vellore, India
| | - Rajat Raghunath
- Department of Surgery Unit-2, Christian Medical College, Vellore, India
| | - Rohin Mittal
- Department of Surgery Unit-2, Christian Medical College, Vellore, India
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10
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Song J, Lu Y. Composite Inflammatory Indicators as Early Predictor of Intra-abdominal Infections after General Surgery. J Inflamm Res 2022; 14:7173-7179. [PMID: 34992412 PMCID: PMC8710522 DOI: 10.2147/jir.s340745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To identify rapid and accurate early diagnostic indicators for intra-abdominal infection (IAI) after general surgery. Methods We conducted a retrospective analysis of 3,810 general surgical patients in our hospital from August 2017 to July 2018. The predictive value of PCT, CRP, TNFα, and IL6 on postoperative days (PODs) 1 and 3 and composite indicators for complicated IAIs among surgical patients was clarified. Results There were 271 patients in the infected group and 614 patients in the uninfected group using IAI diagnostic criteria in this study. CRP, PCT, TNFα, and IL6 in the infected group were significantly higher than the uninfected group on POD1 and POD3. In the infected group, the composition of the four indicators on POD1 (AUC 0.819) and POD3 (AUC 0.848) showed higher predictive efficiency than the individual indicators (AUC 0.670-0.805). Conclusion The composite of CRP, PCT, TNFα, and IL6 can be used as a predictor of postoperative abdominal infectious complications with high sensitivity and specificity on POD1 and POD3, which can provide a basis for early diagnosis of postoperative abdominal infectious complications.
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Affiliation(s)
- Jiakun Song
- Emergency Department, Sandun District of Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
| | - Yurong Lu
- Emergency Department, Sandun District of Zhejiang Hospital, Hangzhou, Zhejiang, People's Republic of China
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11
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Nadal LRM, Silva AMAD, Johann L, Boustani SHE, Medrado MBAS, Farah JFM, Lupinacci RA. C-Reactive Protein as a Marker of Postoperative Complication of Emergency Colorectal Surgery. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1055/s-0041-1736641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Abstract
Introduction The literature converges regarding the use of C-reactive protein (CRP) tests between postoperative days (PODs) 3 and 5 of elective procedures. In this period, they have great sensitivity and negative predictive value (NPV) for severe and anastomotic complications about two days before the first clinical sign. The few studies on colorectal urgency suggest that, despite the different initial values according to the surgical indication, following POD 3, the level of CRP is similar to that of elective procedures. However, given the heterogeneity of the studies, there is no consensus on the cutoff values for this use.
Objective To validate the use and propose a PO CRP cut-off value in urgent colorectal procedures as an exclusion criterion for complications of anastomosis or the abdominal cavity.
Method Retrospective analysis of the medical records of 308 patients who underwent urgent colorectal surgical procedures between January 2017 and December 2019. The following data were considered: age, gender, surgical indication, type of procedure performed, complications, CRP levels preoperatively and from POD 1 to 4, and the severity of the complications. We compared the CRP levels and the percentage variations between the preoperative period and PODs 1 to 4 as markers of severe complications using the receiver operating characteristic (ROC) curve.
Results The levels of CRP on POD4, and their percentage drops between PODs 2 to 4 and PODs 3 to 4, were better to predict severe complications. A cutoff of 7.45 mg/dL on POD 4 had 91.7% of sensitivity and NPV. A 50% drop between PODs 3 and 4 had 100% of sensitivity and NPV.
Conclusion Determining the level of CRP is useful to exclude severe complications, and it could be a criterion for hospital discharge in POD 4 of emergency colorectal surgery.
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Affiliation(s)
- Luis R. M. Nadal
- General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
| | - Artur M. A. da Silva
- General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
| | - Larissa Johann
- Medicine Student, Faculdade de Medicina, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Shuaib H. El Boustani
- Medicine Student, Faculdade de Medicina, Universidade Cidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Jose F. M. Farah
- General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
| | - Renato A. Lupinacci
- General and Oncologic Surgery Service, Hospital do Servidor Público Estadual, São Paulo, São Paulo, Brazil
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12
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Hernandez PT, Paspulati RM, Shanmugan S. Diagnosis of Anastomotic Leak. Clin Colon Rectal Surg 2021; 34:391-399. [PMID: 34853560 DOI: 10.1055/s-0041-1735270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Anastomotic leaks after colorectal surgery is associated with increased morbidity and mortality. Understanding the impact of anastomotic leaks and their risk factors can help the surgeon avoid any modifiable pitfalls. The diagnosis of an anastomotic leak can be elusive but can be discerned by the patient's global clinical assessment, adjunctive laboratory data and radiological assessment. The use of inflammatory markers such as C-Reactive Protein and Procalcitonin have recently gained traction as harbingers for a leak. A CT scan and/or a water soluble contrast study can further elucidate the location and severity of a leak. Further intervention is then individualized on the spectrum of simple observation with resolution or surgical intervention.
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Affiliation(s)
- Paul T Hernandez
- Division of Colorectal Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Raj M Paspulati
- Department of Radiology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | - Skandan Shanmugan
- Department of Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania
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13
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Conti C, Pedrazzani C, Turri G, Gecchele G, Valdegamberi A, Ruzzenente A, Zamboni GA, Lippi G, Guglielmi A. Visceral obesity enhances inflammatory response after laparoscopic colorectal resection. Int J Clin Pract 2021; 75:e14795. [PMID: 34482612 PMCID: PMC9285786 DOI: 10.1111/ijcp.14795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 09/02/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS C-reactive protein (CRP) is used for monitoring postoperative inflammation (POI) and detecting infectious complications. The aim of this study was to assess the effect of visceral obesity (VO) on acute POI measured through CRP after elective laparoscopic colorectal resection. METHODS Pre-operative Computed tomography images of 357 patients who underwent laparoscopic colorectal resection were analyzed. Visceral adipose tissue (VAT) area was measured for each patient. VO was defined as VAT area >163.8 cm2 in men and >80.1 cm2 in women according to accepted sex-specific cut-offs. Postoperative outcomes and CRP values were compared between VO and non-VO groups. The most appropriate CRP value for identifying infectious complications in the two groups was assessed with receiver operating characteristic (ROC) curves. Univariate and multivariate analyses were conducted for factors affecting POI including VO. RESULTS No differences in postoperative outcomes and infectious complications were found in VO patients (62.2% of the overall population). Both in the overall cohort and in patients without infectious complications, VO was associated with higher CRP values on postoperative day (POD) 1, POD2, POD3, and POD5. A positive correlation was found between VAT and CRP on all PODs. VO independently predicted higher CRP on POD1-3 in patients without infectious complications but not in those who developed complications. ROC curves analysis showed optimal accuracy for detection of infectious complications for CRP on POD3 in both groups, though the optimal cut-off value was higher in VO group (154 vs 136 mg/L). CONCLUSIONS VO is not associated to increased complications after laparoscopic colorectal resection. Nevertheless, it is independently associated to higher CRP in the overall population and in patients without infectious complications. Consequently, CRP values on POD3 higher than cut-offs commonly adopted in the clinical practice should be carefully evaluated in VO patients to assess the occurrence of infectious complications.
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Affiliation(s)
- Cristian Conti
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Corrado Pedrazzani
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Giulia Turri
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Gabriele Gecchele
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Alessandro Valdegamberi
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
| | - Giulia A. Zamboni
- Section of RadiologyDepartment of Diagnostic and Public HealthUniversity of VeronaVeronaItaly
| | - Giuseppe Lippi
- Section of Clinical BiochemistryDepartment of Neurological, Biomedical and Movement SciencesUniversity of VeronaVeronaItaly
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary SurgeryDepartment of Surgical Sciences, Dentistry, Gynecology and PediatricsUniversity of VeronaVeronaItaly
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14
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Zhang Y, Li S, Yan C, Chen J, Shan F. Perioperative Use of Glucocorticoids and Intraoperative Hypotension May Affect the Incidence of Postoperative Infection in Patients with Gastric Cancer: A Retrospective Cohort Study. Cancer Manag Res 2021; 13:7723-7734. [PMID: 34675668 PMCID: PMC8517416 DOI: 10.2147/cmar.s333414] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/20/2021] [Indexed: 12/24/2022] Open
Abstract
Background In patients undergoing surgical resection for gastric cancer, postoperative complications—in particular, postoperative infections—remain an important problem and can result in delayed recovery and increased postoperative mortality. Objective To investigate the association between perioperative anesthesia management and postoperative infectious complications in patients undergoing resection for gastric cancer. Design Retrospective cohort study. Setting A single-center study performed from April 1, 2015, to June 30, 2018, at Peking University Cancer Hospital. Patients Patients who underwent resection for gastric cancer. Main Outcome Measures Demographic information, perioperative data (including anesthesia-related data, surgery-related data, and cancer diagnosis), and information on postoperative recovery were recorded. The primary outcome was incidence of postoperative infection; the secondary outcome was length of hospital stay. The associations between perioperative factors and postoperative infectious complications were analyzed using multivariable logistic regression models and the classification tree method. Results A total of 880 patients were included in the study; of these, 111 (12.6%) had postoperative infectious complications during hospitalization, including 78 surgical site infections and 62 remote infections. After correction for confounding factors on logistic multivariable analysis, perioperative use of glucocorticoids was associated with a lower incidence of postoperative infection (hazard ratio 0.968, 95% confidence interval 0.939 to 0.997, P=0.029), and intraoperative systolic blood pressure <90 mmHg for >10 min was associated with a higher incidence of postoperative infection (hazard ratio 2.112, 95% confidence interval 1.174 to 3.801, P=0.013). In addition, older age, preoperative hypoproteinemia, and total gastrectomy were identified as independent predictors of postoperative infection. Conclusion For patients with gastric cancer, perioperative use of glucocorticoids and avoiding intraoperative hypotension may decrease the incidence of postoperative infectious complications.
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Affiliation(s)
- Yunxiao Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Shuo Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Chao Yan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Jiheng Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Anesthesiology, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
| | - Fei Shan
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), The First Department of Gastrointestinal Surgery, Peking University Cancer Hospital & Institute, Beijing, People's Republic of China
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15
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Predictive value of 4th post-operative-day CRP in the early detection of complications after laparoscopic bowel resection for endometriosis. J Gynecol Obstet Hum Reprod 2021; 50:102148. [PMID: 33872816 DOI: 10.1016/j.jogoh.2021.102148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/23/2021] [Accepted: 04/15/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Post-operative CRP on postoperative day 4 (POD) is used for the early detection of complications after colorectal surgery for cancer, but there is no evidence yet that justifies the use of this marker for bowel resection in case of endometriosis. STUDY DESIGN We retrospectively included 66 consecutive patients who underwent bowel resection for endometriosis (stage 4) in Lille university hospital, France, from August 1, 2015 until January 31, 2017. The composite endpoint of our study included anastomotic leakages, infectious or thrombo-embolic complications, hematomas, bowel stenosis, rectorrhagia, voiding dysfunction, and rehospitalization for related symptoms. RESULTS CRP on POD 4 presents a satisfying area under the curve of 0.85, for the composite endpoint. A CRP cut off value of 56 mg/L yielded a sensitivity of 0.61 (IC95%: 0.36 to 0.83) and a specificity of 0.98 (IC95%: 0.89 to 1). The negative and positive predictive values were 0.87 and 0.92. CONCLUSION The negative predictive value of the CRP on POD 4 after bowel resection for endometriosis is a useful early indicator for detecting a complication. Therefore, this biomarker might be safely used as an additional criterion for a safe discharge from hospital after colorectal resection in endometriosis.
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16
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Janet J, Derbal S, Durand Fontanier S, Bouvier S, Christou N, Fabre A, Fredon F, Rivaille T, Valleix D, Mathonnet M, Taibi A. C-reactive protein is a predictive factor for complications after incisional hernia repair using a biological mesh. Sci Rep 2021; 11:4379. [PMID: 33623063 PMCID: PMC7902654 DOI: 10.1038/s41598-021-83663-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 01/20/2021] [Indexed: 12/03/2022] Open
Abstract
The introduction of biological or absorbable synthetic meshes has provided an alternative to conventional repair for incisional hernia. The ability to predict the development of complications after hernia surgery is important, as it guides surgical planning and patient management. This retrospective study assessed whether the postoperative C-reactive protein (CRP) level can predict complications after incisional hernia repair using biological mesh reinforcement. Patients who underwent incisional hernia repair surgery using biological meshes between February 2009 and February 2015 were screened for study inclusion. Patients included in the study were divided into two groups: those with and without postoperative complications. The two groups were analysed based on sex, surgical operation, length of intensive care unit stay (ICU), complications and mortality. Laboratory values, including white blood cell (WBC) count and CRP levels, were determined preoperatively and up to postoperative day (POD) 10. Postoperative complications requiring further management occurred in 32 of the 60 patients (53.3%). Among 47 patients, the mean CRP and WBC levels were 6.6 mg/L and 9.073 G/L in the group without complications vs. 141.0 mg/L, 16.704 G/L in the group with complications (p < 0.001). Patients with complications also had a longer ICU stay (10.1 vs. 0.6 days, p < 0.0001). A cut-off was 101 mg/L and offered 80.00% sensitivity (IC 61.43% to 92.29) and 95.24% specificity (76.18% to 99.88%) for postoperative complication. The rate of postoperative complications before POD10 was 95% in the group with CRP > 100 mg/L vs. 46% in the group with CRP < 100 mg/L (p = 0.000372). A high postoperative CRP level (> 100 mg/L) up to POD10 may serve as a predictor of postoperative complications in patients undergoing incisional hernia using biological meshes.
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Affiliation(s)
- Julien Janet
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Sophiane Derbal
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Sylvaine Durand Fontanier
- Visceral Surgery Department, Limoges University Hospital, Limoges, France.,University Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France
| | - Stephane Bouvier
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Niki Christou
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Anne Fabre
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Fabien Fredon
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Thibaud Rivaille
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Denis Valleix
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Muriel Mathonnet
- Visceral Surgery Department, Limoges University Hospital, Limoges, France
| | - Abdelkader Taibi
- Visceral Surgery Department, Limoges University Hospital, Limoges, France. .,University Limoges, CNRS, XLIM, UMR 7252, 87000, Limoges, France.
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17
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Paradis T, Zorigtbaatar A, Trepanier M, Fiore JF, Fried GM, Feldman LS, Lee L. Meta-analysis of the Diagnostic Accuracy of C-Reactive Protein for Infectious Complications in Laparoscopic Versus Open Colorectal Surgery. J Gastrointest Surg 2020; 24:1392-1401. [PMID: 32314233 DOI: 10.1007/s11605-020-04599-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/06/2020] [Indexed: 01/31/2023]
Abstract
INTRODUCTION C-reactive protein may predict anastomotic complications after colorectal surgery, but its predictive ability may differ between laparoscopic and open resection due to differences in stress response. Therefore, the objective of this study was to perform a systematic review and meta-analysis on the diagnostic characteristics of C-reactive protein to detect anastomotic leaks and infectious complications after laparoscopic and open colorectal surgery. METHODS A systematic review was performed according to PRISMA. Studies were included if they reported on the diagnostic characteristics of postoperative day 3-5 values of serum C-reactive protein to diagnose anastomotic leak or infectious complications specifically in patients undergoing elective laparoscopic and open colorectal surgery. The main outcome was a composite of anastomotic leak and infectious complications. A random-effects model was used to perform a meta-analysis of diagnostic accuracy. RESULTS A total of 13 studies were included (9 for laparoscopic surgery, 8 for open surgery). The pooled incidence of the composite outcome was 14.8% (95% CI 10.2-19.3) in laparoscopic studies and 21.0% (95% CI 11.9-30.0) for open. The pooled diagnostic accuracy characteristics were similar for open and laparoscopic studies. However, the C-reactive protein threshold cutoffs were lower in laparoscopic studies for postoperative days 3 and 4, but similar on day 5. CONCLUSIONS The diagnostic characteristics of C-reactive protein in the early postoperative period to detect infectious complications and leaks are similar after laparoscopic and open colorectal surgery. However, thresholds are lower for laparoscopic surgery, suggesting that the interpretation of serum CRP values needs to be tailored based on operative approach.
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Affiliation(s)
- Tiffany Paradis
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Anudari Zorigtbaatar
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada
| | - Maude Trepanier
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - Julio F Fiore
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - Gerald M Fried
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - Liane S Feldman
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada.,Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada
| | - Lawrence Lee
- Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University Health Centre, Montreal, QC, Canada. .,Department of Surgery, McGill University Health Centre, 1001 Decarie Boulevard, DS1-3310, Montreal, QC, H4A 3J1, Canada.
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18
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Viyuela García C, Medina Fernández FJ, Arjona-Sánchez Á, Casado-Adam Á, Sánchez Hidalgo JM, Rufián Peña S, Briceño Delgado J. Systemic inflammatory markers for the detection of infectious complications and safe discharge after cytoreductive surgery and HIPEC. Surg Oncol 2020; 34:163-167. [PMID: 32891323 DOI: 10.1016/j.suronc.2020.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in patients with ovarian peritoneal carcinomatosis may be associated with a high postoperative morbidity. An early discrimination of postoperative complications is crucial for both improving clinical outcomes and proposing a safe discharge. MATERIAL AND METHODS In a cohort of 122 patients with advanced ovarian cancer (FIGO III-IV), we analyzed the diagnostic performance of three systemic inflammatory markers (C-reactive protein, white blood cell count and systemic immune-inflammation index) between the 5th to 8th postoperative days to prediction postoperative infectious complications. An optimal cut-off value was established in order to discriminate between the group of patients who developed infectious complications or not during the postoperative period. RESULTS The median peritoneal carcinomatosis index (PCI) was 15. The overall infectious morbidity was 25.4% (31 patients out of 122), of which, 32% (10 patients out of 31) had suffered severe postoperative complications (Dindo-Clavien III-IV). The most accurate results for detecting infectious complications were obtained by using C-reactive protein, which presented an excellent diagnostic performance, especially on the 7th and 8th postoperative days (AUC = 0,857 and 0,920; respectively). CONCLUSIONS These results support that it is safe to discharge patients with C-reactive protein concentrations lower than 88 mg/L and 130 mg/L, on the 7th and 8th postoperative days, respectively.
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Affiliation(s)
- Cristina Viyuela García
- Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | - Álvaro Arjona-Sánchez
- Unit of Surgical Oncology, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - Ángela Casado-Adam
- Unit of Surgical Oncology, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - Juan Manuel Sánchez Hidalgo
- Unit of Surgical Oncology, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - Sebastián Rufián Peña
- Unit of Surgical Oncology, Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - Javier Briceño Delgado
- Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain
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19
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Kanda M. Preoperative predictors of postoperative complications after gastric cancer resection. Surg Today 2019; 50:3-11. [PMID: 31535226 PMCID: PMC6949209 DOI: 10.1007/s00595-019-01877-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/01/2019] [Indexed: 12/19/2022]
Abstract
Risk management is becoming an increasingly important healthcare issue. Gastrectomy with lymphadenectomy is still the mainstay of treatment for localized gastric cancer, but it is sometimes associated with postoperative complications that compromise the patient’s quality of life, tolerability of adjuvant treatment, and prognosis. Parameters based exclusively on preoperative factors can identify patients most at risk of postoperative complications, whereby surgeons can provide the patient with precise informed consent information and optimal perioperative management. Ultimately, these predictive tools can also help minimize medical costs. In this context, many studies have identified factors that predict postoperative complications, including indicators based on body constitution, nutrition, inflammation, organ function and hypercoagulation. This review presents our current understanding and discusses some future perspectives of preoperatively identified factors predictive of complications after resection for gastric cancer.
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Affiliation(s)
- Mitsuro Kanda
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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20
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Serum C-reactive protein level after ventral hernia repair with mesh reinforcement can predict infectious complications: a retrospective cohort study. Hernia 2018; 24:41-48. [DOI: 10.1007/s10029-018-1844-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/29/2018] [Indexed: 12/14/2022]
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21
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Zhang K, Huang X, Gao Y, Liang W, Xi H, Cui J, Li J, Zhu M, Liu G, Zhao H, Hu C, Liu Y, Qiao Z, Wei B, Chen L. Robot-Assisted Versus Laparoscopy-Assisted Proximal Gastrectomy for Early Gastric Cancer in the Upper Location: Comparison of Oncological Outcomes, Surgical Stress, and Nutritional Status. Cancer Control 2018; 25:1073274818765999. [PMID: 29582668 PMCID: PMC6852367 DOI: 10.1177/1073274818765999] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: An increasing amount of attention has been paid to minimally invasive function-preserving gastrectomy, with an increase in incidence of early gastric cancer in the upper stomach. This study aimed to compare oncological outcomes, surgical stress, and nutritional status between robot-assisted proximal gastrectomy (RAPG) and laparoscopy-assisted proximal gastrectomy (LAPG). Methods: Eighty-nine patients were enrolled in this retrospective study between November 2011 and December 2013. Among them, 27 patients underwent RAPG and 62 underwent LAPG. Perioperative parameters, surgical stress, nutritional status, disease-free survival, and overall survival were compared between the 2 groups. Results: Sex, age, and comorbidity were similar in the RAPG and LAPG groups. There were also similar perioperative outcomes regarding operation time, complications, and length of hospital stay between the groups. The reflux esophagitis rates following RAPG and LAPG were 18.5% and 14.5%, respectively (P = .842). However, patients in the RAPG group had less blood loss (P = .024), more harvested lymph nodes (P = .021), and higher costs than those in the LAPG group (P < .001). With regard to surgical stress, no significant differences were observed in C-reactive protein concentrations and white blood cell count on postoperative days 1, 3, and 7 between the groups (Ps > .05). There appeared to be higher hemoglobin levels at 6 months (P = .053) and a higher body mass index at 12 months (P = .056) postoperatively in patients in the RAPG group compared with those in the LAPG group, but this difference was not significant. Similar disease-free survival and overall survival rates were observed between the groups. Conclusions: RAPG could be an alternative to LAPG for patients with early gastric cancer in the upper stomach with comparable oncological safety and nutritional status. Further well-designed, prospective, large-scale studies are needed to validate these results.
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Affiliation(s)
- Kecheng Zhang
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.,Kecheng Zhang, Xiaohui Huang, Yunhe Gao and Wenquan Liang contributed equally to this work
| | - Xiaohui Huang
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.,Kecheng Zhang, Xiaohui Huang, Yunhe Gao and Wenquan Liang contributed equally to this work
| | - Yunhe Gao
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.,Kecheng Zhang, Xiaohui Huang, Yunhe Gao and Wenquan Liang contributed equally to this work
| | - Wenquan Liang
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China.,Kecheng Zhang, Xiaohui Huang, Yunhe Gao and Wenquan Liang contributed equally to this work
| | - Hongqing Xi
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Jianxin Cui
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Jiyang Li
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Minghua Zhu
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Guoxiao Liu
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Huazhou Zhao
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Chong Hu
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Yi Liu
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Zhi Qiao
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Bo Wei
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
| | - Lin Chen
- 1 Department of General Surgery, Chinese PLA General Hospital, Beijing 100853, China
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Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol. Wideochir Inne Tech Maloinwazyjne 2018; 13:315-325. [PMID: 30302144 PMCID: PMC6174169 DOI: 10.5114/wiitm.2018.75846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 02/18/2018] [Indexed: 01/26/2023] Open
Abstract
Introduction Thanks 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. Aim To 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 methods The 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. Results Group 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). Conclusions Our 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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Cabellos Olivares M, Labalde Martínez M, Torralba M, Rodríguez Fraile JR, Atance Martínez JC. C-reactive protein as a marker of the systemic inflammatory response to surgery reduction within an enhanced recovery after surgery protocol in elective colorectal surgery of the elderly: A prospective cohort study. SURGICAL PRACTICE 2018. [DOI: 10.1111/1744-1633.12319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Miguel Torralba
- Department of Internal Medicine; University Hospital of Guadalajara; Guadalajara Spain
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Systematic review and meta-analysis of the use of serum procalcitonin levels to predict intra-abdominal infections after colorectal surgery. Int J Colorectal Dis 2018; 33:171-180. [PMID: 29305753 DOI: 10.1007/s00384-017-2956-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE There has been much recent interest in the use of procalcitonin (PCT) as a marker of intra-abdominal infection (IAI) following colorectal surgery. However, the literature remains divided on the value of PCT in this setting. This meta-analysis aims to evaluate the value of PCT in predicting IAI after colorectal surgery. METHODS Systemic literature search was performed using MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Database of Systematic Reviews to identify studies evaluating the diagnostic accuracy of PCT as a predictor for detecting IAI on postoperative days (POD) 3 to 5 following colorectal surgery. A meta-analysis was performed using random effect model and pooled predictive parameters as well as cut-off values for POD 3 to 5 were derived. RESULTS Eight studies consisting 1629 patients were included. The pooled prevalence of IAI was 5.7% on POD 3, 9.7% on POD 4, and 6.3% on POD 5. The pooled AUC for POD 3 to 5 were 0.83 (95% CI 0.78-0.88), 0.79 (95% CI 0.64-0.93), and 0.94 (95% CI 0.91-0.97), respectively. The derived PCT cut-off values were 1.45 ng/ml on POD 3, 1.28 ng/ml on POD 4, and 1.26 ng/ml on POD 5. PCT had the highest diagnostic capability on POD 5 with diagnostic odds ratio of 32.9 (95% CI 15.01-69.88), sensitivity of 0.78 (95% CI 0.65-0.89), and specificity of 0.88 (95% CI 0.85-0.90). CONCLUSIONS PCT is a useful diagnostic predictor of IAI after colorectal surgery. It has the greatest diagnostic accuracy on POD 5 and can help guide safe discharge of patients after colorectal surgery.
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25
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Cabellos Olivares M, Labalde Martínez M, Torralba M, Rodríguez Fraile JR, Atance Martínez JC. C-reactive protein as a marker of the surgical stress reduction within an ERAS protocol (Enhanced Recovery After Surgery) in colorectal surgery: A prospective cohort study. J Surg Oncol 2018; 117:717-724. [PMID: 29355975 DOI: 10.1002/jso.24909] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND The aim of this study is to evaluate the effectiveness of an Enhanced Recovery After Surgery Protocol (ERAS) in relation to reduce the Systemic Inflammatory Response (SIR) to surgery using C-reactive protein (CRP) in the first (POD1), second (POD2) and third (POD3) postoperative day. METHODS We enrolled 121 patients (ERAS group) that underwent elective colorectal surgery with ERAS, and compared them with 135 patients (preERAS group) that had undergone surgery prior to the implementation. We made a univariate analysis to compare the CRP values in POD1, POD2, and POD3 between preERAS/ERAS group, laparoscopic/open surgery and the presence or not of Clavien Dindo complications. Multivariable lineal regression was used to assess if the ERAS had a decreasing effect on the CRP in POD1, POD2, and POD3, and was adjusted by age, male sex, use of laparoscopy, and complications. RESULTS The presence of complications was independently associated with an increase in CRP values in POD1, POD2, and POD3. Laparoscopy in POD1 and POD2, and ERAS in POD2 was independently associated with a decrease in CRP values. CONCLUSION The analysis shows an increase in SIR measured as a CRP value in those patients that had complications. The SIR decreased with laparoscopy in POD1 and POD2 and with ERAS in POD2.
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Affiliation(s)
| | | | - Miguel Torralba
- Department of Internal Medical, Research Unit, Hospital Universitario de Guadalajara. Universidad de Alcalá, Guadalajara, Spain
| | | | - Juan C Atance Martínez
- Department of Health Inspection, Hospital Universitario de Guadalajara. Universidad de Alcalá, Guadalajara, Spain
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26
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C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial. Surg Endosc 2017; 32:2877-2885. [PMID: 29282574 PMCID: PMC5956066 DOI: 10.1007/s00464-017-5996-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 12/02/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND In search of improvement of patient assessment in the postoperative phase, C-reactive protein (CRP) is increasingly being studied as an early marker for postoperative complications following major abdominal surgery. Several studies reported an attenuated immune response in minimally invasive surgery, which might affect interpretation of postoperative CRP levels. The aim of the present study was to compare the value of CRP as a predictor for major postoperative complications in patients undergoing open versus laparoscopic colorectal surgery. METHODS A subgroup analysis from a randomized clinical trial (LAFA-trial) was performed, including all patients with non-metastasized colorectal cancer. In the LAFA trial, patients were randomized to open or laparoscopic segmental colectomy. In a subgroup of 79 patients of the LAFA trial, postoperative assessment of CRP levels was conducted routinely preoperatively and 1, 2, 24 and 72 h after surgery. RESULTS Thirty-seven patients were randomized to the open group and 42 patients to the laparoscopic group. Major complications occurred in 19% of laparoscopic procedures and 13.5% of open procedures (p = 0.776). CRP levels rise following surgical procedures. In uncomplicated cases, the rise in CRP levels was significantly lower at 24 and 72 h following laparoscopic resection in comparison to open resection. No differences in CRP levels were observed when comparing open and laparoscopic resection in patients with major complications. CONCLUSION In patients with an uncomplicated postoperative course, CRP levels were lower following minimally invasive resection, possibly due to decreased operative trauma. No differences in CRP were observed stratified for surgical technique in patients with major complications. These results suggest that CRP may be applied as a marker for major postoperative complications in both open and minimally invasive colorectal surgery. Future research should aim to assess the role of standardized postoperative CRP measurements.
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27
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Ramos Fernández M, Rivas Ruiz F, Fernández López A, Loinaz Segurola C, Fernández Cebrián JM, de la Portilla de Juan F. Proteína C reactiva como predictor de fuga anastomótica en cirugía colorrectal. Comparación entre cirugía abierta y laparoscópica. Cir Esp 2017; 95:529-535. [DOI: 10.1016/j.ciresp.2017.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 06/05/2017] [Accepted: 08/21/2017] [Indexed: 01/27/2023]
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28
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Facy O, Paquette B, Orry D, Santucci N, Rat P, Rat P, Binquet C, Ortega-Deballon P. Inflammatory markers as early predictors of infection after colorectal surgery: the same cut-off values in laparoscopy and laparotomy? Int J Colorectal Dis 2017; 32:857-863. [PMID: 28386662 DOI: 10.1007/s00384-017-2805-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE C-reactive protein and procalcitonin are reliable early predictors of infection after colorectal surgery. However, the inflammatory response is lower after laparoscopy as compared to open surgery. This study analyzed whether a different cutoff value of inflammatory markers should be chosen according to the surgical approach. METHODS A prospective, observational study included consecutive patients undergoing elective colorectal surgery in three academic centers. All infections until postoperative day (POD) 30 were recorded. The inflammatory markers were analyzed daily until POD 4. Areas under the ROC curve and diagnostic values were calculated in order to assess their accuracy as a predictor of intra-abdominal infection. RESULTS Five-hundred-one patients were included. The incidence of intra-abdominal infection was 11.8%. The median levels of C-reactive protein (CRP) and procalcitonin (PCT) were lower in the laparoscopy group at each postoperative day (p < 0.0001). In patients without intra-abdominal infection, they were also lower in the laparoscopy group (p = 0.0036) but were not different in patients presenting with intra-abdominal infections (p = 0.3243). In the laparoscopy group, CRP at POD 4 was the most accurate predictor of overall and intra-abdominal infection (AUC = 0.775). With a cutoff of 100 mg/L, it yielded 95.7% negative predictive value, 75% sensitivity, and 70.3% specificity for the detection of intra-abdominal infection. CONCLUSION The impact of infection on inflammatory markers is more important than that of the surgical approach. Defining a specific cutoff value for early discharge according to the surgical approach is not justified. A patient with CRP values lower than 100 mg/L on POD 4 can be safely discharged.
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Affiliation(s)
- Olivier Facy
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, 21079, Dijon Cedex, France. .,INSERM, U866, Dijon, France. .,University of Bourgogne-Franche-Comté, UMR866, Dijon, France.
| | - Brice Paquette
- Department of Digestive Surgery, Besançon University Hospital, Besançon, France
| | - David Orry
- Department of Surgery, Anticancer Centre "Georges-François Leclerc", Dijon, France
| | - Nicolas Santucci
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, 21079, Dijon Cedex, France.,INSERM, U866, Dijon, France.,University of Bourgogne-Franche-Comté, UMR866, Dijon, France
| | - Paul Rat
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, 21079, Dijon Cedex, France.,INSERM, U866, Dijon, France.,University of Bourgogne-Franche-Comté, UMR866, Dijon, France
| | - Patrick Rat
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, 21079, Dijon Cedex, France.,INSERM, U866, Dijon, France.,University of Bourgogne-Franche-Comté, UMR866, Dijon, France
| | - Christine Binquet
- INSERM, U866, Dijon, France.,University of Bourgogne-Franche-Comté, UMR866, Dijon, France.,INSERM, CIC1432, Dijon, France.,Clinical Investigation Centre, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France
| | - Pablo Ortega-Deballon
- Department of Digestive Surgery, Dijon University Hospital, 14, Rue Paul Gaffarel, 21079, Dijon Cedex, France.,INSERM, U866, Dijon, France.,University of Bourgogne-Franche-Comté, UMR866, Dijon, France
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29
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Juvany M, Guirao X, Oliva JC, Badía Pérez JM. Role of Combined Post-Operative Venous Lactate and 48 Hours C-Reactive Protein Values on the Etiology and Predictive Capacity of Organ-Space Surgical Site Infection after Elective Colorectal Operation. Surg Infect (Larchmt) 2017; 18:311-318. [DOI: 10.1089/sur.2016.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Xavier Guirao
- Unit of Endocrine, Head, and Neck Surgery and Unit of Surgical Infections Support, Department of General Surgery, Parc Taulí, Hospital Universitari, Sabadell, Spain
| | - Joan Carles Oliva
- Statistical Unit, Parc Taulí Fundation-University Institute UAB, Corporació Parc Taulí, Sabadell, Spain
| | - Jose M. Badía Pérez
- Department of General Surgery, Hospital General de Granollers, Granollers, Spain
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30
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Pedrazzani C, Moro M, Mantovani G, Lazzarini E, Conci S, Ruzzenente A, Lippi G, Guglielmi A. C-reactive protein as early predictor of complications after minimally invasive colorectal resection. J Surg Res 2016; 210:261-268. [PMID: 28457337 DOI: 10.1016/j.jss.2016.11.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/30/2016] [Accepted: 11/28/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND Minimally invasive surgery (MIS) and enhanced recovery programs have been increasingly adopted in colorectal surgery. The aim of this prospective observational study was to evaluate the usefulness of the C-reactive protein (CRP) concentration measured on postoperative day 3 (POD-3) as an early predictor of severe complications after minimally invasive colorectal resection. MATERIALS AND METHODS From January 2014 to December 2015, 160 patients underwent resection of colorectal disease by MIS at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust. Among these, CRP measurement was available on POD-3 in 143 patients. RESULTS Conversion from laparoscopic to open surgery was necessary in 18 patients (12.6%). The mean POD-3 CRP concentration was significantly higher in patients who did than did not require conversions (205.6 ± 89.6 mg/L versus 104.6 ± 85.8 mg/L, respectively; P < 0.001), even in the absence of postoperative complications, and these patients were therefore excluded from the subsequent analysis. No deaths occurred during the study period, but complications occurred in 39 patients (31.2%). Among these, 24 patients (61.5%) developed surgery-related complications. A POD-3 CRP concentration of 120 mg/L was highly reliable for excluding the occurrence of surgery-related and severe complications. The negative predictive values for excluding surgery-related and severe complications was 86.8% and 97.7%, respectively. CONCLUSIONS Assessment of the POD-3 CRP concentration after colorectal MIS is clinically significant for excluding the occurrence of surgery-related and severe complications. This measurement is a largely available, inexpensive, and easy-to-use tool that allows early and safe discharge in the setting of colorectal MIS and enhanced recovery programs.
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Affiliation(s)
- Corrado Pedrazzani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
| | - Margherita Moro
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Guido Mantovani
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Enrico Lazzarini
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Simone Conci
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Andrea Ruzzenente
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy
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31
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van Rooijen SJ, Huisman D, Stuijvenberg M, Stens J, Roumen RMH, Daams F, Slooter GD. Intraoperative modifiable risk factors of colorectal anastomotic leakage: Why surgeons and anesthesiologists should act together. Int J Surg 2016; 36:183-200. [PMID: 27756644 DOI: 10.1016/j.ijsu.2016.09.098] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/12/2016] [Accepted: 09/26/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Colorectal anastomotic leakage (CAL) is a major surgical complication in intestinal surgery. Despite many optimizations in patient care, the incidence of CAL is stable (3-19%) [1]. Previous research mainly focused on determining patient and surgery related risk factors. Intraoperative non-surgery related risk factors for anastomotic healing also contribute to surgical outcome. This review offers an overview of potential modifiable risk factors that may play a role during the operation. METHODS Two independent literature searches were performed using EMBASE, Pubmed and Cochrane databases. Both clinical and experimental studies published in English from 1985 to August 2015 were included. The main outcome measure was the risk of anastomotic leakage and other postoperative complications during colorectal surgery. Determined risk factors of CAL were stated as strong evidence (level I and II high quality studies), and potential risk factors as either moderate evidence (experimental studies level III), or weak evidence (level IV or V studies). RESULTS The final analysis included 117 articles. Independent factors of CAL are diabetes mellitus, hyperglycemia and a high HbA1c, anemia, blood loss, blood transfusions, prolonged operating time, intraoperative events and contamination and a lack of antibiotics. Unequivocal are data on blood pressure, the use of inotropes/vasopressors, oxygen suppletion, type of analgesia and goal directed fluid therapy. No studies could be found identifying the impact of body core temperature or mean arterial pressure on CAL. Subjective factors such as the surgeons' own assessment of local perfusion and visibility of the operating field have not been the subject of relevant studies for occurrence in patients with CAL. CONCLUSION Both surgery related and non-surgery related risk factors that can be modified must be identified to improve colorectal care. Surgeons and anesthesiologists should cooperate on these items in their continuous effort to reduce the number of CAL. A registration study determining individual intraoperative risk factors of CAL is currently performed as a multicenter cohort study in the Netherlands.
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Affiliation(s)
- S J van Rooijen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands.
| | - D Huisman
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - M Stuijvenberg
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
| | - J Stens
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - R M H Roumen
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
| | - F Daams
- VU Medical Center, Department of Surgery, Amsterdam, The Netherlands
| | - G D Slooter
- Máxima Medical Center, Department of Surgery, Veldhoven, The Netherlands
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32
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Diagnostic Accuracy of Inflammatory Markers As Early Predictors of Infection After Elective Colorectal Surgery: Results From the IMACORS Study. Ann Surg 2016; 263:961-6. [PMID: 26135691 DOI: 10.1097/sla.0000000000001303] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Intra-abdominal infections are frequent and life-threatening complications after colorectal surgery. An early detection could diminish their clinical impact and permit safe early discharge. OBJECTIVE This study aimed to find the most accurate marker for the detection of postoperative intra-abdominal infection and the appropriate moment to measure it. METHODS A prospective, observational study was conducted in 3 centers. Consecutive patients undergoing elective colorectal surgery with anastomosis were included. C-reactive protein and procalcitonin were measured daily until the fourth postoperative day. Postoperative infections were recorded according to the definitions of the Centres for Diseases Control. The areas under the receiver operating characteristic curve were analyzed and compared to assess the diagnostic accuracy of each marker. RESULTS Five-hundred and one patients were analyzed. The incidence of intra-abdominal infection was 11.8%, with 24.6% of patients presenting at least one infectious complication. Overall mortality was 1.2%. At the fourth postoperative day, C-reactive protein was more discriminating than procalcitonin for the detection of intra-abdominal infection (areas under the ROC curve: 0.775 vs 0.689, respectively, P = 0.03). Procalcitonin levels showed wide dispersion. For the detection of all infectious complications, C-reactive protein was also significantly more accurate than procalcitonin on the fourth postoperative day (areas under the ROC curve: 0.783 vs 0.671, P = 0.0002). CONCLUSIONS C-reactive protein is more accurate than procalcitonin for the detection of infectious complications and should be systematically measured at the fourth postoperative day. It is a useful tool to ensure a safe early discharge after elective colorectal surgery.
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33
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Mullen JT. Identifying Candidates for Early Discharge After Gastrectomy: "It's Tough to Make Predictions, Especially About the Future". Ann Surg Oncol 2016; 24:8-10. [PMID: 27444108 DOI: 10.1245/s10434-016-5452-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Indexed: 11/18/2022]
Affiliation(s)
- John T Mullen
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street Yawkey 7B, Boston, MA, USA.
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34
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Zhang K, Xi H, Wu X, Cui J, Bian S, Ma L, Li J, Wang N, Wei B, Chen L. Ability of Serum C-Reactive Protein Concentrations to Predict Complications After Laparoscopy-Assisted Gastrectomy: A Prospective Cohort Study. Medicine (Baltimore) 2016; 95:e3798. [PMID: 27227957 PMCID: PMC4902381 DOI: 10.1097/md.0000000000003798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Inflammatory markers, including C-reactive protein (CRP) and white blood cell (WBC), are widely available in clinical practice. However, their predictive roles for infectious complications following laparoscopy-assisted gastrectomy (LAG) have not been investigated. Our aim was to investigate the diagnostic accuracy of CRP concentrations and WBC counts for early detection of infectious complications following LAG and to construct a nomogram for clinical decision-making.The clinical data of consecutive patients who underwent LAG with curative intent between December 2013 and March 2015 were prospectively collected. Postoperative complications were recorded according to the Clavien-Dindo classification. The diagnostic value of CRP concentrations and WBC counts was evaluated by area under the curve of receiver-operating characteristic curves. Optimal cutoff values were determined by Youden index. Univariate and multivariate logistic regression analyses were performed to identify risk factors for complications, after which a nomogram was constructed.Twenty-nine of 278 patients (10.4%) who successfully underwent LAG developed major complications (grade ≥III). CRP concentration on postoperative day 3 (POD 3) and WBC count on POD 7 had the highest diagnostic accuracy for major complications with an area under the curve value of 0.86 (95% confidence interval [CI], 0.79-0.92] and 0.68 (95% CI, 0.56-0.79) respectively. An optimal cutoff value of 172.0 mg/L was identified for CRP, yielding a sensitivity of 0.79 (95% CI, 0.60-0.92) and specificity 0.74 (95% CI, 0.68-0.80). Multivariate analysis identified POD3 CRP concentrations ≥172.0 mg/L, Eastern Cooperative Oncology Group Performance Status ≥1, presence of preoperative comorbidity, and operation time ≥240 min as risk factors for major complications after LAG.The optimal cut-off value of CRP on POD3 to predict complications following LAG was 172.0 mg/L and a CRP-based nomogram may contribute to early detection of complications after LAG.
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Affiliation(s)
- Kecheng Zhang
- From the Department of General Surgery, Chinese People's Liberation Army General Hospital, Beijing, China
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35
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Straatman J, de Weerdesteijn EDW, Tuynman JB, Cuesta MA, van der Peet DL. C-Reactive Protein as a Marker for Postoperative Complications. Are There Differences in Emergency and Elective Colorectal Surgery? Dis Colon Rectum 2016; 59:35-41. [PMID: 26651110 DOI: 10.1097/dcr.0000000000000506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND C-reactive protein levels are frequently raised in patients with major complications following elective colorectal surgery and used as a predictor for complications. The significance of raised C-reactive protein levels to predict outcome in emergency colorectal surgery is unclear, because preoperative C-reactive protein levels are often raised. OBJECTIVE The aim of this study was to determine whether serum C-reactive protein is an adequate predictive marker for major postoperative complications after colorectal surgery in an acute setting. DESIGN This is an observational cohort study of all patients undergoing colorectal surgery. PATIENTS Consecutive patients undergoing colorectal surgery with reconstruction via anastomosis and/or stoma from January 2009 to March 2014 were included. SETTING This study was conducted at VU University Medical Center, Amsterdam. MAIN OUTCOME MEASURES Postoperative C-reactive protein levels, operative details, and postoperative complications were recorded to determine the differences in C-reactive protein as a marker for complications in emergency and elective colorectal surgery. RESULTS A total of 724 patients underwent colorectal resection, 559 elective cases and 165 emergency cases. A major complication was observed in 176 of 724 patients (24.3%). Major complications were observed more often in patients who underwent emergency surgery, 37% versus 20.9% after elective resections. C-reactive protein levels were significantly higher preoperatively in patients operated on in an acute care setting and on the first two postoperative days; from the third postoperative day, no statistically significant differences were found in C-reactive protein levels. LIMITATIONS This study was limited by its observational nature. CONCLUSIONS Although acute colorectal surgery is associated with higher C-reactive protein levels in the first 2 postoperative days, this study shows that postoperative C-reactive protein levels may be used as a predictor for complications in both acute and elective surgery from the third postoperative day onward. It is hypothesized that the stimulus for C-reactive protein production is removed during surgery, and, with a short-half-life of 19 hours, C-reactive protein levels drop to similar levels as seen in patients undergoing elective surgery.
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Affiliation(s)
- Jennifer Straatman
- Department of Surgery, VU University Medical Center, Amsterdam, the Netherlands
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C-reactive protein is a predictor of complications after elective laparoscopic colorectal surgery: five-year experience. Wideochir Inne Tech Maloinwazyjne 2015; 10:418-22. [PMID: 26649089 PMCID: PMC4653262 DOI: 10.5114/wiitm.2015.54077] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 06/02/2015] [Accepted: 06/06/2015] [Indexed: 12/27/2022] Open
Abstract
Introduction With the development and improvement of laparoscopic surgery, procedures have become common. However, post-operative complications occur when patients are released from hospital. These complications increase patients’ morbidity and mortality. They also lead to re-hospitalization, an extended recovery period, and an increase in the cost of treatment. Aim To evaluate and determine the prognostic properties of C-reactive protein in the early diagnosis of postoperative complications after a laparoscopic colon resection. Material and methods The prospective study included patients who underwent laparoscopic colorectal surgery in 2010–2014. The patients were divided into two groups – uncomplicated ones and those with complications. C-reactive protein concentrations in their blood serum were measured on the 2nd, 4th and 6th day after surgery. Logistic regression analysis was used to evaluate the relation between C-reactive protein values measured on the 2nd, 4th and 6th postoperative day and related complications. Receiver operating characteristic curves were used to determine the sensitivity and specificity of each C-reactive protein value measured on the 2nd, 4th and 6th postoperative day. Results One hundred and six patients were included in the trial; 14 of them had complications. On the second day, a C-reactive protein cut-off value of 88.6 mmol/l provided the highest sensitivity and specificity for predicting evolving complications, being 71.4% and 84.8% respectively (p = 0.003). The significant predictive cut-off value decreases and becomes more sensitive and specific each post-operative day. Conclusions It is possible to detect developing post-operative complications early on by monitoring C-reactive protein concentration levels in the blood serum on the 2nd, 4th, and 6th post-operative days.
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Straatman J, Harmsen AMK, Cuesta MA, Berkhof J, Jansma EP, van der Peet DL. Predictive Value of C-Reactive Protein for Major Complications after Major Abdominal Surgery: A Systematic Review and Pooled-Analysis. PLoS One 2015; 10:e0132995. [PMID: 26177542 PMCID: PMC4503561 DOI: 10.1371/journal.pone.0132995] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 12/21/2022] Open
Abstract
Background Early diagnosis and treatment of complications after major abdominal surgery can decrease associated morbidity and mortality. Postoperative CRP levels have shown a strong correlation with complications. Aim of this systematic review and pooled-analysis was to assess postoperative values of CRP as a marker for major complications and construct a prediction model. Study design A systematic review was performed for CRP levels as a predictor for complications after major abdominal surgery (MAS). Raw data was obtained from seven studies, including 1427 patients. A logit regression model assessed the probability of major complications as a function of CRP levels on the third postoperative day. Two practical cut-offs are proposed: an optimal cut-off for safe discharge in a fast track protocol and another for early identification of patients with increased risk for major complications. Results A prediction model was calculated for major complications as a function of CRP levels on the third postoperative day. Based on the model several cut-offs for CRP are proposed. For instance, a two cut-off system may be applied, consisting of a safe discharge criterion with CRP levels below 75 mg/L, with a negative predictive value of 97.2%. A second cut-off is set at 215 mg/L (probability 20%) and serves as a predictor of complications, indicating additional CT-scan imaging. Conclusions The present study provides insight in the interpretation of CRP levels after major abdominal surgery, proposing a prediction model for major complications as a function of CRP on postoperative day 3. Cut-offs for CRP may be implemented for safe early-discharge in a fast-track protocol and, secondly as a threshold for additional examinations, such as CT-scan imaging, even in absence of clinical signs, to confirm or exclude major complications. The prediction model allows for setting a cut-off at the discretion of individual surgeons or surgical departments.
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Affiliation(s)
- Jennifer Straatman
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Annelieke M. K. Harmsen
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Miguel A. Cuesta
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands
| | - Johannes Berkhof
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - Elise P. Jansma
- Medical Library, VU University Medical Center, Amsterdam, the Netherlands
| | - Donald L. van der Peet
- Department of Gastrointestinal Surgery, VU University Medical Center, Amsterdam, the Netherlands
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Adamina M, Steffen T, Tarantino I, Beutner U, Schmied BM, Warschkow R. Meta-analysis of the predictive value of C-reactive protein for infectious complications in abdominal surgery. Br J Surg 2015; 102:590-8. [PMID: 25776855 DOI: 10.1002/bjs.9756] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Revised: 10/27/2014] [Accepted: 11/25/2014] [Indexed: 01/05/2023]
Abstract
BACKGROUND The aim of this analysis was to assess the predictive value of C-reactive protein (CRP) for the early detection of postoperative infectious complications after a variety of abdominal operations. METHODS A meta-analysis of seven cohort studies from a single institution was performed. Laparoscopic gastric bypass and colectomies, as well as open resections of cancer of the colon, rectum, pancreas, stomach and oesophagus, were included. The predictive value of CRP was assessed by the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS Of 1986 patients, 577 (29·1 (95 per cent c.i. 27·1 to 31·3) per cent) had at least one postoperative infectious complication. Patients undergoing laparoscopic gastric bypass (383 patients) or colectomy (285), and those having open gastric (97) or colorectal (934) resections were combined in a meta-analysis. Patients who had resection for cancer of the oesophagus (41) or pancreas (246) were analysed separately owing to heterogeneity. CRP levels 4 days after surgery had the highest diagnostic accuracy (AUC 0·76, 95 per cent c.i. 0·73 to 0·78). Sensitivity and specificity were 68·5 (60·6 to 75·5) and 71·6 (66·6 to 76·0) per cent respectively. Positive and negative predictive values were 50·4 (46·0 to 54·8) and 84·3 (80·8 to 87·3) per cent. The threshold CRP varied according to the procedure performed. CONCLUSION The negative predictive value of serum CRP concentration on day 4 after surgery facilitates reliable exclusion of postoperative infectious complications.
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Affiliation(s)
- M Adamina
- Departments of Surgery, Kantonsspital Winterthur, Winterthur, Switzerland
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