The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study

Matthijs Plas,Abraham Rutgers,Hanneke Van Der Wal-Huisman,Jacco J De Haan,Anthony R Absalom,Geertruida H De Bock,Barbara L Van Leeuwen

doi:10.1016/j.jgo.2020.01.013

Abstract

BackgroundAccurate prognostic biomarkers would substantially improve surgical planning and decisions making yet no studies have been reported exploring the inflammatory response in surgically treated older patients with cancer. The aim of this study was to explore inflammatory biomarkers as potential prognostic factors for postoperative complications within 30 days in older patients with cancer. MethodPatients 65 years and older undergoing surgery for removal of a solid malignant tumour were included in an observational cohort study. All complications occurring up to 30 days postoperatively were documented prospectively. Inflammatory markers were measured in plasma samples pre- and postoperatively: C-reactive protein (CRP), Interleukin-1 beta (IL-1β), IL-6, IL-10, IL-12, and Tumour necrosis factor-alpha (TNF-α). Associations between inflammatory markers and postoperative complications were explored using logistic regression analysis. ResultsBetween July 2010 and April 2014, plasma samples of 224 patients were collected. Median age was 72 (65–89) years and 116 (51.8%) patients were female. Approximately half of the patients developed postoperative complications (49.6%) of whom 62 patients (55.9%) developed >1 complication. An independent prognostic effect was observed for the inflammatory biomarkers IL-6 and IL-10 for the occurrence of postoperative complications. ConclusionThe perioperative inflammatory response is associated with complications, independently from patient and surgical factors which are also associated with outcome. Research is warranted towards further exploration of the perioperative inflammatory response with the aim to improve perioperative care and outcome, and might help to improve surgical planning and decision making for older patients with cancer.

Highlights

Older patients diagnosed with cancer may benefit from surgical treatment, they are more susceptible to the complications of surgery and anaesthesia than younger patients [1]
The inflammatory biomarkers IL-12 and TNF-α did not show a peroperative change in plasma levels and were not used for further analysis
Univariable logistic regression analyses showed that different inflammatory biomarkers (CRP, IL-6 and IL-10) were associated with the occurrence of postoperative complications

Summary

Introduction

Older patients diagnosed with cancer may benefit from surgical treatment, they are more susceptible to the complications of surgery and anaesthesia than younger patients [1]. The frequency of postoperative complications in older patients undergoing elective surgery for solid tumour removal is relatively high, with incidences reported of N50% during the first 30 days postoperatively [2,3]. Accurate prognostic biomarkers would substantially improve surgical planning and decisions making yet no studies have been reported exploring the inflammatory response in surgically treated older patients with cancer. The aim of this study was to explore inflammatory biomarkers as potential prognostic factors for postoperative complications within 30 days in older patients with cancer. Research is warranted towards further exploration of the perioperative inflammatory response with the aim to improve perioperative care and outcome, and might help to improve surgical planning and decision making for older patients with cancer

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Discussion

Conclusion