Ramanathan Michelle L, MacKay Graham, Platt Jonathan, Horgan Paul G, McMillan Donald C
Academic Department of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK,
Ann Surg Oncol. 2015 Mar;22(3):938-43. doi: 10.1245/s10434-014-4065-z. Epub 2014 Sep 9.
There is increasing evidence that C-reactive protein is a useful negative predictor of infective complications and anastomotic leak following surgery for colorectal cancer. In particular, C-reactive protein concentrations on postoperative days 3 and 4 have been proposed to be of clinical utility since they aid safe and early discharge of selected patients following colorectal surgery. However, it is not clear whether such thresholds are also applicable in laparoscopic surgery. The aim of the present study was to compare the value of daily C-reactive protein concentrations in the prediction of postoperative infective complications in patients undergoing open versus laparoscopic resection for colon cancer.
Patients with histologically proven colon cancer who were considered to have undergone potentially curative resection in one of two university teaching hospitals in Glasgow were included in the study (n = 344). Patient characteristics were collected in a prospective surgical database. All resections were elective cases and were performed using either open (n = 191) or laparoscopic surgery (n = 153). Daily blood samples to measure C-reactive protein concentrations perioperatively were taken routinely. Patients were assessed for postoperative infective and non-infective complications.
The majority of patients were aged 65 years or older (75%), male (52%), had left-sided tumors (54%), node negative disease (77%), and did not undergo neoadjuvant treatment (94%). Patients undergoing open and laparoscopic resection were similar in terms of age, sex, tumor site, TNM stage, comorbidity, and infective complications. In contrast, preoperative and postoperative days 1-3 C-reactive protein concentrations were lower following laparoscopic compared with open resection in the whole cohort (n = 344; all p < 0.001) and in those who did not develop infective complications (n = 251; all p < 0.001). The median length of hospital stay was shorter in the laparoscopic resection (p < 0.001). During follow-up, 127 (37%) patients developed a postoperative complication, 93 (73%) of which were infective complications. In those who developed an infective complication, there was no significant difference in the C-reactive protein concentrations between open and laparoscopic resections on postoperative days 1-4. C-reactive protein thresholds predictive of infective complications were the same on postoperative days 3 (180 mg/l) and 4 (140 mg/l) following both open and laparoscopic resection for colon cancer.
The results of the present study show that although the magnitude of the systemic inflammatory response, as evidenced by C-reactive protein, following surgery was greater in open compared with laparoscopic resection, the threshold concentrations of C-reactive protein for the development of postoperative infective complications were remarkably similar on days 3 and 4.
越来越多的证据表明，C反应蛋白是结直肠癌手术后感染性并发症和吻合口漏的有用阴性预测指标。特别是，有人提出术后第3天和第4天的C反应蛋白浓度具有临床实用性，因为它们有助于结直肠手术后部分患者的安全早期出院。然而，尚不清楚这些阈值是否也适用于腹腔镜手术。本研究的目的是比较开放性与腹腔镜结肠癌切除术患者每日C反应蛋白浓度在预测术后感染性并发症方面的价值。
本研究纳入了在格拉斯哥的两家大学教学医院之一接受了可能治愈性切除且经组织学证实为结肠癌的患者（n = 344）。患者特征收集于前瞻性手术数据库。所有切除均为择期病例，采用开放性手术（n = 191）或腹腔镜手术（n = 153）进行。常规采集围手术期每日血样以测量C反应蛋白浓度。对患者进行术后感染性和非感染性并发症评估。
大多数患者年龄在65岁及以上（75%），男性（52%）,患有左侧肿瘤（54%），淋巴结阴性疾病（77%），且未接受新辅助治疗（94%）。接受开放性和腹腔镜切除术的患者在年龄、性别、肿瘤部位、TNM分期、合并症和感染性并发症方面相似。相比之下，在整个队列（n = 344；所有p < 0.001）以及未发生感染性并发症的患者中（n = 251；所有p < 0.001），腹腔镜切除术后1至3天的术前和术后C反应蛋白浓度低于开放性切除。腹腔镜切除术的中位住院时间较短（p < 0.001）。在随访期间，127例（37%）患者出现术后并发症，其中93例（73%）为感染性并发症。在发生感染性并发症的患者中，开放性和腹腔镜切除术后1至4天的C反应蛋白浓度无显著差异。结肠癌开放性和腹腔镜切除术后第3天（180 mg/l）和第4天（140 mg/l）预测感染性并发症的C反应蛋白阈值相同。
本研究结果表明，尽管如C反应蛋白所证明的那样，开放性手术术后全身炎症反应的程度大于腹腔镜切除术，但术后第３天和第4天发生术后感染性并发症的C反应蛋白阈值浓度非常相似。
