Fernández-Candela A, Barber X, López-Rodríguez-Arias F, Lario-Pérez S, Calero A, Aranaz-Ostáriz V, Caravaca-García I, Lillo-García C, Sánchez-Guillén L, Lacueva FJ. Early prediction of postoperative infection using inflammatory markers after cytoreductive surgery for peritoneal carcinomatosis. World J Gastrointest Surg 2025; 17(5): 101323 [DOI: 10.4240/wjgs.v17.i5.101323]
Corresponding Author of This Article
Alba Fernández-Candela, FACS, Department of General Surgery, Peritoneal Carcinomatosis Unit, Elche University General Hospital, Carrer Almazara, 11, Elche 03202, Valencia, Spain. albafmed@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. May 27, 2025; 17(5): 101323 Published online May 27, 2025. doi: 10.4240/wjgs.v17.i5.101323
Early prediction of postoperative infection using inflammatory markers after cytoreductive surgery for peritoneal carcinomatosis
Alba Fernández-Candela, Xavier Barber, Francisco López-Rodríguez-Arias, Sandra Lario-Pérez, Alicia Calero, Verónica Aranaz-Ostáriz, Iban Caravaca-García, Cristina Lillo-García, Luis Sánchez-Guillén, Francisco-Javier Lacueva
Alba Fernández-Candela, Francisco López-Rodríguez-Arias, Sandra Lario-Pérez, Alicia Calero, Verónica Aranaz-Ostáriz, Iban Caravaca-García, Cristina Lillo-García, Luis Sánchez-Guillén, Francisco-Javier Lacueva, Department of General Surgery, Peritoneal Carcinomatosis Unit, Elche University General Hospital, Elche 03202, Valencia, Spain
Xavier Barber, Joint Research Unit UMH-FISABIO, Center of Operations Research, Universidad Miguel Hernandez, Elche 03202, Valencia, Spain
Francisco-Javier Lacueva, Department of Pathology and Surgery, Universidad Miguel Hernandez, Elche 03202, Valencia, Spain
Co-corresponding authors: Alba Fernández-Candela and Francisco-Javier Lacueva.
Author contributions: Fernández-Candela A, Sánchez-Guillén L, López-Rodríguez-Arias F, and Lacueva FJ designed the research study; Caravaca-García I, Calero A, and Aranaz-Ostáriz V performed the research; Fernández-Candela A, Lario-Pérez S, and Lillo-García C performed the data collection; Barber X, Lario-Pérez S, López-Rodríguez-Arias F, and Fernández-Candela A analyzed the data; Fernández-Candela A, Sánchez-Guillén L, and Lacueva FJ wrote the manuscript; All authors have read and approved the final manuscript. Fernández-Candela A and Lacueva FJ contributed equally to this article, and are the co-corresponding authors of this manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Elche General Hospital (Approval No. PI 21/2018).
Informed consent statement: All study participants, or their legal guardian, provided written informed consent prior to surgery.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at fj.lacueva@umh.es. Participants gave informed consent for data sharing.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Alba Fernández-Candela, FACS, Department of General Surgery, Peritoneal Carcinomatosis Unit, Elche University General Hospital, Carrer Almazara, 11, Elche 03202, Valencia, Spain. albafmed@gmail.com
Received: September 10, 2024 Revised: December 2, 2024 Accepted: March 11, 2025 Published online: May 27, 2025 Processing time: 254 Days and 7.4 Hours
Abstract
BACKGROUND
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.
AIM
To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections (OPIs) after CRS +/- HIPEC.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
