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Agnello L, Buscemi S, Di Buono G, Vidali M, Lo Sasso B, Agrusa A, Ciaccio M. Drainage fluid LDH and neutrophil to lymphocyte ratio as biomarkers for early detecting anastomotic leakage in patients undergoing colorectal surgery. Clin Chem Lab Med 2024; 62:967-978. [PMID: 37988156 DOI: 10.1515/cclm-2023-1164] [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: 07/11/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES In this study, we investigated the role of several circulating and drainage fluid biomarkers for detecting postoperative complications (PCs) and anastomotic leakage (AL) in patients undergoing colorectal surgery. METHODS All consecutive patients undergoing colorectal surgery between June 2018 and April 2020 were prospectively considered. On postoperative days (POD) 1, 3, and 5, we measured lactate dehydrogenase (LDH) in drainage fluid, C-reactive protein (CRP) in serum and drainage fluid, and neutrophil to lymphocyte ratio (NLR). RESULTS We enrolled 187 patients. POD1 patients with AL had higher serum CRP levels, while on POD3 and on POD5 higher NLR and serum CRP. LDH and CRP in drainage fluid were also significantly higher at both time points. The area under the curves (AUCs) of serum and drainage fluid CRP were 0.752 (0.629-0.875) and 0.752 (0.565-0.939), respectively. The best cut-off for serum and drainage fluid CRP was 185.23 and 76 mg/dL, respectively. The AUC of NLR on POD3 was 0.762 (0.662-0.882) with a sensitivity and specificity of 84 and 63 %, respectively, at a cut-off of 6,6. Finally, drainage fluid LDH showed the best diagnostic performance for AL, with an AUC, sensitivity, and specificity of 0.921 (0.849-0.993), 82 %, and 90 % at a cut-off of 2,186 U/L. Trends in serum parameters between patients with or without PCs or AL were also evaluated. Interestingly, we found that NLR decreased faster in patients without PCs than in patients with PCs and patients with AL. CONCLUSIONS Drainage fluid LDH and NLR could be promising biomarkers of PCs and AL.
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Affiliation(s)
- Luisa Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matteo Vidali
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Bruna Lo Sasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
- Department of Laboratory Medicine, AOUP "P. Giaccone", Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
- Department of Laboratory Medicine, AOUP "P. Giaccone", Palermo, Italy
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Gielen AHC, Schoenmakers M, Breukink SO, Winkens B, van der Horst J, Wevers KP, Melenhorst J. The value of C-reactive protein, leucocytes and vital signs in detecting major complications after oncological colorectal surgery. Langenbecks Arch Surg 2024; 409:76. [PMID: 38409295 PMCID: PMC10896856 DOI: 10.1007/s00423-024-03266-3] [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: 09/15/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To assess the association of postoperative C-reactive protein (CRP), leucocytes and vital signs in the first three postoperative days (PODs) with major complications after oncological colorectal resections in a tertiary referral centre for colorectal cancer in The Netherlands. METHODS A retrospective cohort study, including 594 consecutive patients who underwent an oncological colorectal resection at Maastricht University Medical Centre between January 2016 and December 2020. Descriptive analyses of patient characteristics were performed. Logistic regression models were used to assess associations of leucocytes, CRP and Modified Early Warning Score (MEWS) at PODs 1-3 with major complications. Receiver operating characteristic curve analyses were used to establish cut-off values for CRP. RESULTS A total of 364 (61.3%) patients have recovered without any postoperative complications, 134 (22.6%) patients have encountered minor complications and 96 (16.2%) developed major complications. CRP levels reached their peak on POD 2, with a mean value of 155 mg/L. This peak was significantly higher in patients with more advanced stages of disease and patients undergoing open procedures, regardless of complications. A cut-off value of 170 mg/L was established for CRP on POD 2 and 152 mg/L on POD 3. Leucocytes and MEWS also demonstrated a peak on POD 2 for patients with major complications. CONCLUSIONS Statistically significant associations were found for CRP, Δ CRP, Δ leucocytes and MEWS with major complications on POD 2. Patients with CRP levels ≥ 170 mg/L on POD 2 should be carefully evaluated, as this may indicate an increased risk of developing major complications.
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Affiliation(s)
- Anke H C Gielen
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.
| | - Maud Schoenmakers
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Jischmaël van der Horst
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Kevin P Wevers
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht, The Netherlands
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Park BS, Cho SH, Lee SH, Son GM, Kim HS. Role of C-Reactive Protein, White Blood Cell Counts, and Serum Glucose Levels as Early Predictors of Infectious Complications After Laparoscopic Colorectal Surgery for Colorectal Cancer. Am Surg 2023; 89:5821-5828. [PMID: 36270320 DOI: 10.1177/00031348221135786] [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] [Indexed: 01/21/2023]
Abstract
BACKGROUND The early detection of infectious complications of colorectal surgery leads to better patient outcomes. This study aimed to assess the role of C-reactive protein (CRP), white blood cell count (WBC), and serum glucose in the early prediction of infectious complications of laparoscopic colorectal surgery. METHODS Patients who underwent laparoscopic colorectal surgery were included and stratified into two groups: infectious complication (IC) or no infectious complication (non-IC). Serum levels were measured on postoperative days (PODs) 2 and 4. RESULTS Analysis of 224 patients (IC group: 27, Non-IC group: 197) revealed higher CRP levels in IC group on POD 2 (P = .001). On POD 4, CRP levels and WBC counts were higher in IC group (P<.001, P = .011, respectively). The area under the curve (AUC) of the receiver operating characteristic (ROC) for CRP on PODs 2 and 4 were .743 and .907, respectively, and for WBC on POD 4 was .687. The cut-offs of CRP on PODs 2 and 4 were 156.2 mg/L and 91.3 mg/L, respectively; the cut-off of WBC was 7,220 cells/mm3. Sensitivity of CRP level ≥91.3 mg/L or WBC count ≥7,220 cells/mm3 was 96.3%; (cf. 88.9% for CRP alone), and specificity of CRP level ≥91.3 mg/L and WBC count ≥7,220 cells/mm3 was 93.4% (cf. 82.2% for CRP alone). DISCUSSION The CRP level on postoperative day (POD) 2 and the combined CRP and WBC on POD 4 were meaningful in predicting infectious complications after laparoscopic colorectal surgery. However, serum glucose levels had a low predictive value for infectious complications.
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Affiliation(s)
- Byung-Soo Park
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Sung Hwan Cho
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Si Hak Lee
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Gyung Mo Son
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hyun Sung Kim
- Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan National University School of Medicine, Yangsan, Republic of Korea
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Abstract
BACKGROUND Elective stoma closure is a common, standardized procedure in digestive surgery. OBJECTIVE This study aimed to evaluate the feasibility of day-case surgery for elective stoma closure. DESIGN This is a prospective, single-center, nonrandomized study of consecutive patients undergoing day-case elective stoma closure. SETTING This study was performed at a French tertiary hospital between January 2016 and June 2018. PATIENTS Elective stoma closure was performed by local incision with an ASA score of I, II, or stabilized III. OUTCOME MEASURES The primary end point was the day-case surgery success rate in the overall population (all patients having undergone elective stoma closure) and in the per protocol population (patients not fulfilling any of the preoperative or perioperative exclusion criteria). The secondary end points (in the per protocol population) were the overall morbidity rate (according to the Clavien-Dindo classification), the major morbidity rate (Clavien score ≥3), and day-case surgery quality criteria (unplanned consultation, unplanned hospitalization, and unplanned reoperation). RESULTS Between January 2016 and June 2018, 236 patients (the overall population; mean ± SD age: 54 ± 17; 120 men (51%)) underwent elective stoma closure. Fifty of these patients (21%) met all the inclusion criteria and constituted the per protocol population. The day-case surgery success rate was 17% (40 of 236 patients) in the overall population and 80% (40 of 50 patients) in the per protocol population. In the per protocol population, the overall morbidity rate was 30% and the major morbidity rate was 6%. Of the 40 patients with successful day-case surgery, the unplanned consultation rate and the unplanned hospitalization rate were both 32.5%. There were no unplanned reoperations. LIMITATIONS This was a single-center study. CONCLUSION In selected patients, day-case surgery for elective stoma closure is feasible and has acceptable complication and readmission rates. Day-case elective stoma closure can therefore be legitimately offered to selected patients. See Video Abstract at http://links.lww.com/DCR/B583. RESULTADOS A CORTO PLAZO DEL CIERRE DE ESTOMA AMBULATORIO UN ESTUDIO OBSERVACIONAL Y PROSPECTIVO ANTECEDENTES:El cierre electivo de un estoma es un procedimiento común y estandarizado en cirugía digestiva.OBJETIVO:Evaluar la viabilidad de la cirugía ambulatoria para el cierre electivo de estomas.DISEÑO:Un estudio prospectivo, unicéntrico, no aleatorizado de pacientes consecutivos sometidos a cierre de estoma electivo ambulatorio.ESCENARIO:Un hospital terciario francés entre enero de 2016 y junio de 2018.PACIENTES:Cierre electivo de estoma realizado por incisión local con una puntuación de la American Society of Anesthesiologists de I, II o III estabilizado.PRINCIPALES MEDIDAS DE RESULTADO:El resultado principal fue la tasa de éxito de la cirugía ambulatoria en la población general (todos los pacientes habiendo sido sometidos a cierre de estoma electivo) y en la población por protocolo (pacientes que no cumplían con ninguno de los criterios de exclusión preoperatorios o perioperatorios). Los resultados secundarios (en la población por protocolo) fueron la tasa de morbilidad general (según la clasificación de Clavien-Dindo), la tasa de morbilidad mayor (puntuación de Clavien ≥ 3) y los criterios de calidad de la cirugía ambulatoria (consulta no planificada, hospitalización no planificada y reoperación no planificada).RESULTADOS:Entre enero de 2016 y junio de 2018, 236 pacientes (la población general; edad media ± desviación estándar: 54 ± 17; 120 hombres (51%)) se sometieron al cierre electivo del estoma. Cincuenta de estos pacientes (21%) cumplieron todos los criterios de inclusión y constituyeron la población por protocolo. La tasa de éxito de la cirugía ambulatoria fue del 17% (40 de 236 pacientes) en la población general y del 80% (40 de 50 pacientes) en la población por protocolo. En la población por protocolo, la tasa de morbilidad general fue del 30% y la tasa de morbilidad mayor fue del 6%. De los 40 pacientes con cirugía ambulatoria exitosa, la tasa de consultas no planificadas y la tasa de hospitalización no planificada fueron ambas del 32.5%. No hubo reoperaciones no planificadas.LIMITACIONES:Este fue un estudio de un solo centro.CONCLUSIÓN:En pacientes seleccionados, la cirugía ambulatoria para el cierre electivo de estoma es factible y tiene tasas aceptables de complicaciones y reingreso. Por lo tanto, se puede ofrecer legítimamente el cierre electivo ambulatorio de estoma a pacientes seleccionados. Consulte Video Resumen en http://links.lww.com/DCR/B583.
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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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Clinical malnutrition predictive model among gynecologic cancer patients prior to elective operation: A cross-sectional study. Clin Nutr 2021; 40:4373-4379. [PMID: 33485706 DOI: 10.1016/j.clnu.2021.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 01/03/2021] [Accepted: 01/06/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Malnutrition is common among cancer patients regardless of stage of cancer. Given the strong association between malnutrition with prolonged hospitalization, delayed recovery and even higher post-operative complications among gynaecologic cancer (GC) patients, it is important to understand its predictive factors. The current study aimed to determine malnutrition predictors among GC patients before elective operation. METHOD A cross-sectional study was conducted among surgical GC patients who were admitted for elective surgery. Data on socio-demographic characteristics, clinical status (diagnosis, the staging of cancer, comorbidities and family history on cancer), anthropometric measures [ Body Mass Index (BMI), weight changes, the percentage of weight loss past one month, muscle mass, fat mass, fat-free mass and mid-upper arm circumference (MUAC)], biochemical profiles [C-reactive protein, albumin and C-reactive protein (CRP) to albumin ratio (CAR)], handgrip strength, total daily energy and protein intake, and malnutrition status [scored Patient Generated-Subjective Global Assessment (PG-SGA)] were assessed during admission. RESULTS Study recruited 124 participants and 57.2% (n = 71) were malnourished. Mean for age, weight changes past one month, handgrip strength, total daily energy and protein intake, PG-SGA score and CAR of participants were 49.9 ± 12.5 years, -4.9 ± 7.2%, 15.6 ± 6.2 kg, 25±7 kcal/kg/day, 1.0 ± 0.3 g/kg/day, 6.5 ± 5.4 and 0.7 ± 1.9, respectively. Multiple linear regression test revealed that the percentage of weight loss past one month, haemoglobin, CRP and handgrip strength were the significant predictors of malnutrition. CONCLUSION Malnutrition is common among GC patient even before elective operation. The early malnutrition screening following with proper nutritional intervention is crucial to optimize nutritional status among GC patients before elective operation.
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Asmar AE, Bendavides M, Moreau M, Hendlisz A, Deleporte A, Khalife M, Donckier V, Liberale G. Postoperative C-reactive protein kinetics predict postoperative complications in patients treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for peritoneal carcinomatosis. World J Surg Oncol 2020; 18:311. [PMID: 33243287 PMCID: PMC7694318 DOI: 10.1186/s12957-020-02081-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 11/09/2020] [Indexed: 03/31/2024] Open
Abstract
BACKGROUND Relatively high morbidity rates are reported after cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC). However, early predictors of complications after CRS plus HIPEC have not been identified. The aim of this study was to evaluate the predictive role of early postoperative serum C-reactive protein (CRP) level (Day 2-4) for the detection of post-operative complications. PATIENTS AND METHODS We performed a retrospective study including 94 patients treated with complete CRS (R1) and HIPEC for PC from various primary origins (2011-2016). Post-operative complications were recorded. The values for postoperative inflammatory markers (white blood cells [WBC] and platelet counts, CRP) were compared between the different groups. RESULTS CRP on post-operative days 2-4 was significantly higher in patients with than without complications (124 mg/L vs 46 mg/L; p < 0.0001) and higher in those with more major complications (162 mg/L vs 80 mg/L; p < 0.0012). WBC and platelet counts showed no difference within 5 days postoperatively. CONCLUSION CRP levels, and kinetics mainly, between post-operative day 2 and 4, are decisive predictive markers of early and late post-operative complications after CRS plus HIPEC. The presence of post-operative complications should be suspected in patients with a high CRP mean, and a plateau level (days 2-4).
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Affiliation(s)
- Antoine El Asmar
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 121, Blvd. de Waterloo, 1000, Brussels, Belgium.
| | - Melissa Bendavides
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 121, Blvd. de Waterloo, 1000, Brussels, Belgium
| | - Michel Moreau
- Department of Statistics, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Alain Hendlisz
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Amélie Deleporte
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Maher Khalife
- Department of Anesthesiology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Donckier
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 121, Blvd. de Waterloo, 1000, Brussels, Belgium
| | - Gabriel Liberale
- Department of Surgical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, 121, Blvd. de Waterloo, 1000, Brussels, Belgium
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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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Macciò A, Chiappe G, Kotsonis P, Lavra F, Nieddu R, Onnis P, Sanna E, Mais V, Madeddu C. The utility of fibrinogen level as a predictor of complications after laparoscopic gynecologic surgery: a prospective observational study. GYNECOLOGICAL SURGERY 2019; 16:11. [DOI: 10.1186/s10397-019-1064-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 10/10/2019] [Indexed: 09/27/2023]
Abstract
AbstractBackgroundComplications after laparoscopic gynecological surgery may increase patients’ morbidity and mortality; therefore, their timely diagnosis and early treatment would help clinicians to avoid life-threatening situations. We aimed to evaluate the predictive role of fibrinogen for diagnosing complications after laparoscopic gynecologic surgery for benign and malignant conditions.Patients and methodsAll patients who underwent elective laparoscopic gynecologic surgery between June 2013 and December 2017 at the Department of Gynecologic Oncology, Azienda Ospedaliera Brotzu, Cagliari, were prospectively included. Post-operative complications were assessed and graded according to the Clavien-Dindo classification. Fibrinogen and white blood cell level were determined preoperatively, on the first post-operative day and at the appearance of symptoms indicative of an irregular post-operative course or at the time of re-hospitalization for persistent symptoms. The postoperative changes (calculated from the first postoperative day) were correlated with the occurrence and severity of complications and their predictive role was assessed.ResultsWe enrolled 1016 patients: 36% underwent surgery for benign pathologies (mainly voluminous fibromatous uteri and severe deep endometriosis) and 64% for gynecologic malignancies. The overall complication rate was of 3.45%, the rate of major postoperative complications was 2.85%. A postoperative fibrinogen increase ≥ 20% had a high diagnostic accuracy to identify postoperative complications early (AUC 0.931, sensitivity 89%, and specificity 99%). The magnitude of postoperative fibrinogen change was associated with complication severity.ConclusionsOur findings demonstrated that fibrinogen increase can enable the early detection of postoperative complications after laparoscopic gynecological surgery. Further prospective and multi-center studies are warranted to confirm these results.
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Pedrazzani C, Conti C, Turri G, Lazzarini E, Tripepi M, Scotton G, Rivelli M, Guglielmi A. Impact of age on feasibility and short-term outcomes of ERAS after laparoscopic colorectal resection. World J Gastrointest Surg 2019; 11:395-406. [PMID: 31681461 PMCID: PMC6821935 DOI: 10.4240/wjgs.v11.i10.395] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There is still large debate on feasibility and advantages of fast-track protocols in elderly population after colorectal surgery.
AIM To investigate the impact of age on feasibility and short-term results of enhanced recovery protocol (ERP) after laparoscopic colorectal resection.
METHODS Data from 225 patients undergoing laparoscopic colorectal resection and ERP between March 2014 and July 2018 were retrospectively analyzed. Three groups were considered according to patients’ age: Group A, 65 years old or less, Group B, 66 to 75 years old and Group C, 76 years old or more. Clinic and pathological data were compared amongst groups together with post-operative outcomes including post-operative overall and surgery-specific complications, mortality and readmission rate. Differences in post-operative length of stay and adherence to ERP’s items were evaluated in the three study groups.
RESULTS Among the 225 patients, 112 belonged to Group A, 57 to Group B and 56 to Group C. Thirty-day overall morbidity was 32.9% whilst mortality was nihil. Though the percentage of complications progressively increased with age (25.9% vs 36.8% vs 42.9%), no differences were observed in the rate of major complications (4.5% vs 3.5% vs 1.8%), prolonged post-operative ileus (6.2% vs 12.2% vs 10.7%) and anastomotic leak (2.7% vs 1.8% vs 1.8%). Significant differences in recovery outcomes between groups were observed such as delayed urinary catheter removal (P = 0.032) and autonomous deambulation (P = 0.013) in elderly patients. Although discharge criteria were achieved later in older patients (3 d vs 3 d vs 4 d, P = 0.040), post-operative length of stay was similar in the 3 groups (5 d vs 6 d vs 6 d).
CONCLUSION ERPs can be successfully and safely applied in elderly undergoing laparoscopic colorectal resection.
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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 Hospital Trust, Verona 37134, Italy
| | - Cristian Conti
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
| | - Giulia Turri
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
| | - Enrico Lazzarini
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
| | - Marzia Tripepi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
| | - Giovanni Scotton
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
| | - Matteo Rivelli
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
| | - Alfredo Guglielmi
- Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona Hospital Trust, Verona 37134, Italy
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You X, Zhou Q, Song J, Gan L, Chen J, Shen H. Preoperative albumin-to-fibrinogen ratio predicts severe postoperative complications in elderly gastric cancer subjects after radical laparoscopic gastrectomy. BMC Cancer 2019; 19:931. [PMID: 31533682 PMCID: PMC6751606 DOI: 10.1186/s12885-019-6143-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 09/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A high prevalence of postoperative complications is closely associated with a worse short- and long-term outcome. This current study aimed to investigate potential risk factors including albumin-to-fibrinogen ratio (AFR) for severe postoperative complications (SPCs) in surgical gastric cancer (GC) patients. METHODS Elderly patients (≥65 years) with primary GC who underwent elective radical laparoscopic gastrectomy under general anesthesia were included. According to the Clavien-Dindo classification system, the severity of complications was assessed from Grade I to V and SPCs were defined as C-D Grade ≥ IIIa. The clinicopathological features, operative-associated characteristics, postoperative recovery and laboratory tests were compared between patients with or without SPCs. Receiver operating characteristic (ROC) curve analysis using Youden's Index was established for determining the predictive value and cut-off threshold of AFR for SPCs. Binary univariate and multivariate logistic regression models were used to assess factors influencing SPCs. RESULTS A total of 365 elderly GC patients were finally included in the analysis, of which 52 (52/365, 14.2%) patients had developed SPCs within postoperative 30 days. Preoperative AFR level predicted SPCs in surgical GC patients with an AUC of 0.841, a sensitivity of 76.36% and a specificity of 80.77%, respectively (P < 0.001). The multivariate analysis revealed that a lower AFR level (OR: 1.94, 95% CI: 1.09-3.36, P = 0.017) and an older age (OR: 1.81, 95% CI: 1.06-3.04, P = 0.023) were two independent predictive factors for SPCs in surgical GC patients. CONCLUSIONS Preoperative AFR level is a useful predictor for SPCs in elderly GC subjects after radical laparoscopic gastrectomy.
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Affiliation(s)
- Xuexue You
- Department of Anesthesiology, Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Qun Zhou
- Department of Anesthesiology, Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Jie Song
- Department of Anesthesiology, Jiangxi Maternal and Child Health Hospital, Nanchang, China
| | - Linguang Gan
- Department of Anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, No.41 Xibei Road, Haishu District, Ningbo, Zhejiang Province, China
| | - Junping Chen
- Department of Anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, No.41 Xibei Road, Haishu District, Ningbo, Zhejiang Province, China
| | - Huachun Shen
- Department of Anesthesiology, HwaMei Hospital, University of Chinese Academy of Sciences, No.41 Xibei Road, Haishu District, Ningbo, Zhejiang Province, 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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Pedrazzani C, Conti C, Mantovani G, Fernandes E, Turri G, Lazzarini E, Menestrina N, Ruzzenente A, Guglielmi A. Laparoscopic colorectal surgery and Enhanced Recovery After Surgery (ERAS) program: Experience with 200 cases from a single Italian center. Medicine (Baltimore) 2018; 97:e12137. [PMID: 30170452 PMCID: PMC6392905 DOI: 10.1097/md.0000000000012137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
There is increasing evidence that minimally invasive techniques associated with Enhanced Recovery After Surgery (ERAS) protocols reduce surgery-related stress and promote faster recovery after major colorectal surgery. As a single tertiary referral center for colorectal surgery, our aim was to analyze the effects of our ERAS protocol on a heterogeneous population undergoing laparoscopic colorectal surgery.Prospectively collected data from 283 patients undergoing laparoscopic colorectal resection at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust, between March 2014 and March 2018 were retrospectively analyzed. Patients' adherence to pre-, intra-, and postoperative ERAS protocol items together with surgical short-term outcomes such as morbidity, mortality, length of hospital stay, and readmission rate was considered.The study protocol was approved by the Ethics Committee of Azienda Ospedaliera Universitaria Integrata di Verona (CRINF-1034 CESC).During the study period, 200 patients met the inclusion criteria and were enrolled in the ERAS protocol. In this series, 34% of patients were aged 70 years or older. Rectal resections represented 26% of all cases, with stoma formation performed in 14.5% of patients. Despite such procedural heterogeneity, good short-term results were obtained: by postoperative day (POD) 2, 58.5% of patients had full return of bowel function, while 63.5% and 88% achieved regular soft diet intake and autonomous walking, respectively. Median (range) length of hospital stay was 5.5 days (2-40) with 71% of patients being discharged by POD 6. No postoperative mortality was recorded, and the rate of major complications was 3.5%. During the study period, 6 patients required redo surgery (3%) and 5 patients required rehospitalization within 30 days (2.5%).This study analyzing the results of the fast-track program in our first 200 cases confirms the feasibility and safety of ERAS protocol application within a heterogeneous population undergoing laparoscopic colonic and rectal resection for benign and malignant diseases.
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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
| | - Cristian Conti
- 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
| | - Eduardo Fernandes
- Division of Minimally Invasive, General and Robotic Surgery, University of Illinois at Chicago, Chicago
| | - Giulia Turri
- 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
| | - Nicola Menestrina
- Division of Anesthesiology, 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
| | - 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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