Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.101323
Revised: December 2, 2024
Accepted: March 11, 2025
Published online: May 27, 2025
Processing time: 254 Days and 13.3 Hours
Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC). C-reactive protein (CRP) is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications, as is the neutrophil-to-lymphocyte ratio (NLR). In patients with peritoneal carcinomatosis, postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.
To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections (OPIs) after CRS +/- HIPEC.
Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital, in whom complete or optimal cytoreduction was achieved, were analyzed retrospectively. A total of 111 patients were included in this study. CRP and NRL values prior to surgery and during the first four postoperative days (PODs) were recorded, along with immunonutrition intake. Their association with OPI and intra-abdominal infections during the first week after surgery was evaluated.
Of the 111 patients included, 19 presented OPI and 8 intra-abdominal infections. Patients with infections had a higher number of digestive anastomoses than those without (1 vs 0.5, P = 0.053 and 1.2 vs 0.6, P = 0.049) and longer length of stay (19 vs 14.9 days, P = 0.022 and 22.3 vs 15.1 days, P = 0.006). CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7% and a specificity of 74.2% to detect OPI. No differences in NLR values were observed. Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI. Subsequently, on POD3 and POD4, patients with OPI presented with higher levels of CRP than patients without infection, regardless of the immunonutrition intake.
CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS. A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.
Core Tip: In this study, inflammatory markers C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio were evaluated retrospectively in patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy to establish the association of theses markers with overall postoperative infections (OPIs). The effect of preoperative immunonutrition intake on these markers was also analyzed. The main finding of the study was the difference in CRP kinetics between patients administered or not administered preoperative immunonutrition. We also conclude that tracking CRP kinetics may be more helpful for predicting OPIs than establishing a specific cut-off point. By contrast, neutrophil-to-lymphocyte ratio levels did not accurately predict OPI in these patients.