Abstract

Gastrectomy for gastric cancer is associated with significant infective postoperative complications. C-reactive protein (CRP) is a useful biomarker in the early detection of infective complications following major abdominal surgery. This single-centre retrospective study aimed to determine the relationship between postoperative CRP levels and development of postoperative infective complications after gastrectomy. Daily postoperative CRP levels were analyzed to determine a CRP threshold associated with infective complications. ROC curve analysis was used to determine which postoperative day (POD) gave the optimal cutoff. Multivariate analysis was performed to determine significant factors associated with complications. One hundred and forty-four patients were included. A total of 61 patients (42%) had at least one infective complication. A CRP level of 220 mg/L was associated with the highest AUC (0.765) with a sensitivity of 70% and specificity of 76% (positive predictive value, 67%; negative predictive value, 78%). More patients with a CRP > 220 mg/L on POD 3 developed infective complications (67% vs. 21%, p < 0.001). A CRP of more than 220 mg/L on POD 3 may be useful to alert clinicians to the increased risk of a postoperative infective complication or enable earlier safe discharge from critical care for those with a lower value.

Highlights

  • Gastric cancer is the third most common malignancy and the fourth most common cause of cancer‐related mortality globally, posing a significant burden of disease worldwide.[1]

  • Survival rates of most cancers have significantly increased over time, mortality associated with gastric cancer remains high[2] and subtotal or total gastrectomy in association with various chemotherapy regimens remains the only curative intervention to date

  • The classification of postoperative complications was formed by the information available on electronic medical records both for patients who recovered in intensive care unit (ICU) and Surgical High Dependency Unit (SHDU)

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Summary

| INTRODUCTION

Gastric cancer is the third most common malignancy and the fourth most common cause of cancer‐related mortality globally, posing a significant burden of disease worldwide.[1]. Postoperative complications are often only diagnosed after the patient develops clinical symptoms or signs, requiring further major interventions such as reoperation and unplanned intensive care unit (ICU) admission, prolonging hospital stay, and putting the patient at further risk of additional morbidity or mortality. Such complications are thought to be associated with disease recurrence and poorer long‐term survival due to suppression of the anticancer adaptive immune system.[17,18]. Identifying a CRP threshold based on a large cohort provides a prognostic indicator that could prompt early investigations and close monitoring for patients who are high‐risk for postoperative complications, while simultaneously aiding safer critical care step‐down and discharge for those less likely to develop complications

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