Prediction of outcome after curative surgery for colorectal cancer: preoperative haemoglobin, C-reactive protein and albumin

595 Background: The postoperative systemic inflammatory response, as evidenced by C-reactive protein (CRP) on day 3 (threshold ~170 mg/L) and day 4 (threshold ~130mg/L), have been reported to be associated with the development of infective complications following surgery for colorectal cancer. The aim of the present study was to assess the impact of the peak, day 2 CRP, on CRP concentrations at day 3 and day 4. Methods: Patients with colorectal cancer who were considered to have undergone elective curative resection were recorded in a prospective database (n=396). CRP was measured preoperatively and on days 1 to 4 postoperatively. Correlations between day 2 CRP and other perioperative CRP concentrations were examined. Results: The majority of patients were 65 or older (67%), male (55%), had colonic tumours (66%), had node negative disease (57%) and were from a deprived area (55%). Day 2 CRP was not associated not with age (p=0.055), sex (p=0.185), deprivation (p=0.103), tumour site (p=0.529) or stage (p=0.395). Day 2 CRP was directly associated with day 1 (r2=0.421, p<0.001), day 3 (r2=0.617, p<0.001) and day 4 (r2=0.315, p<0.001) CRP, but not preoperative CRP (r2=0.008, p=0.084). The median day 2 CRP that corresponded with the previously described thresholds (~170mg/L and ~130mg/L at day 3 and 4 respectively) for predicting infective complications was 190mg/L. Similarly, the median day 2 CRP corresponding to the previously described thresholds (~190mg/L and ~140mg/L at day 3 and 4 respectively) for predicting an anastomotic leak was 200mg/L. Conclusions: A day 2 CRP concentration >190 - 200mg/L, was associated with day 3 and 4 CRP concentrations above established CRP thresholds for the development of infective complications. It remains to be determined whether reduction in day 2 CRP concentrations will reduce infective complications following surgery for colorectal cancer.

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Impact of Day 2 C-Reactive Protein on Day 3 and 4 Thresholds Associated With Infective Complications Following Curative Surgery for Colorectal Cancer

World Journal of Surgery ◽

10.1007/s00268-013-2177-4 ◽

2013 ◽

Vol 37 (11) ◽

pp. 2705-2710 ◽

Cited By ~ 19

Author(s):

Michelle L. Ramanathan ◽

Graham MacKay ◽

Jonathan Platt ◽

Paul G. Horgan ◽

Donald C. McMillan

Keyword(s):

Colorectal Cancer ◽

C Reactive Protein ◽

Curative Surgery ◽

Reactive Protein ◽

Infective Complications

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C-reactive protein/albumin ratio predicts survival after curative surgery in elderly patients with colorectal cancer

Updates in Surgery ◽

10.1007/s13304-021-01011-9 ◽

2021 ◽

Author(s):

Koki Tamai ◽

Shu Okamura ◽

Shunichiro Makino ◽

Noriyuki Yamamura ◽

Nariaki Fukuchi ◽

...

Keyword(s):

Colorectal Cancer ◽

Elderly Patients ◽

C Reactive Protein ◽

Curative Surgery ◽

Albumin Ratio ◽

Reactive Protein ◽

Surgery In Elderly

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Sex, Type of Surgery, and Surgical Site Infections Are Associated with Perioperative Cortisol in Colorectal Cancer Patients

Journal of Clinical Medicine ◽

10.3390/jcm10040589 ◽

2021 ◽

Vol 10 (4) ◽

pp. 589

Author(s):

Mariusz G. Fleszar ◽

Paulina Fortuna ◽

Marek Zawadzki ◽

Paweł Hodurek ◽

Iwona Bednarz-Misa ◽

...

Keyword(s):

Colorectal Cancer ◽

Open Surgery ◽

Surgical Site Infections ◽

Time Profile ◽

C Reactive Protein ◽

Robot Assisted ◽

Related Factors ◽

Reactive Protein ◽

Baseline Cortisol ◽

Colorectal Cancer Patients

Excessive endocrine response to trauma negatively affects patients’ well-being. Cortisol dynamics following robot-assisted colorectal surgery are unknown. We aimed at determining the impact of cancer pathology and surgery-related factors on baseline cortisol levels and analyzed its time-profile in colorectal cancer patients undergoing open or robot-assisted surgery. Cortisol levels were measured using liquid chromatography quadrupole time-of-flight mass spectrometry. Baseline cortisol was not associated with any patient- or disease-related factors. Post-surgery cortisol increased by 36% at 8 h and returned to baseline on postoperative day three. The cortisol time profile was significantly affected by surgery type, estimated blood loss, and length of surgery. Baseline-adjusted cortisol increase was greater in females at hour 8 and in both females and patients from open surgery group at hour 24. Solely in the open surgery group, cortisol dynamics paralleled changes in interleukin (IL)-1β, IL-10, IL-1ra, IL-7, IL-8 and tumor necrosis factor (TNF)-α but did not correlate with changes in IL-6 or interferon (IFN)-γ at any time-point. Cortisol co-examined with C-reactive protein was predictive of surgical site infections (SSI) with high accuracy. In conclusion, patient’s sex and surgery invasiveness affect cortisol dynamics. Surgery-induced elevation can be reduced by minimally invasive robot-assisted procedures. Cortisol and C-reactive protein as SSI biomarkers might be of value in the evaluation of safety of early discharge of patients.

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Lymphocyte C-reactive protein ratio: A new biomarker to predict early complications after gastrointestinal oncologic surgery

Cancer Biomarkers ◽

10.3233/cbm-210251 ◽

2021 ◽

pp. 1-9

Author(s):

Murat Yildirim ◽

Bulent Koca

Keyword(s):

Colorectal Cancer ◽

Postoperative Complications ◽

Inflammatory Markers ◽

Operation Time ◽

C Reactive Protein ◽

Oncologic Surgery ◽

Protein Ratio ◽

Colorectal Cancer Surgery ◽

Neutrophil Lymphocyte Ratio ◽

Reactive Protein

BACKGROUND: Lymphocyte-to-C-reactive protein ratio (LCR) has been used as a post-surgical prognostic biomarker in patients with gastric and colorectal cancer. However, its relationship with early postoperative complications in these patients is unknown. In this study, we aimed to reveal the relationship between LCR and postoperative complications. METHODS: Eighty-one patients operated for stomach and colorectal cancer between January 2020 and August 2020 were prospectively analyzed. On preoperative and postoperative days 1, 3 and 5, other inflammatory parameters, mainly LCR, neutrophil lymphocyte ratio (NLR), were recorded. The patients were divided into two groups according to Clavien-Dindo classification as stage III and higher complications major, stage I-II/non-complication minor. RESULTS: Fifty seven patients were operated for colorectal cancer, 24 patients for gastric cancer. The mean age of the patients was 65.6 ± 12.6, 34.6% of them was women. Age, operation time and hospital stay were significantly different between the groups (p= 0.004, p= 0.002, p< 0.001). Major complications developed in 18 patients. On postoperative day 5, LCR found superior diagnostic accuracy in predicting major postoperative complications compared to other inflammatory markers. On the postoperative 5th day, the cut-off value of LCR was 0.0034, 88.8% (71.9–94.8) sensitivity, and 85.7% (73.6–95.4) selectivity. CONCLUSION: Among different inflammatory markers, postoperative LCR is a safe and effective predictor of postoperative complications, especially after gastric and colorectal cancer surgery on day 5.

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