Pedrazzani Corrado, Moro Margherita, Mantovani Guido, Lazzarini Enrico, Conci Simone, Ruzzenente Andrea, Lippi Giuseppe, Guglielmi Alfredo
Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
Division of General and Hepatobiliary Surgery, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, Verona, Italy.
J Surg Res. 2017 Apr;210:261-268. doi: 10.1016/j.jss.2016.11.047. Epub 2016 Dec 5.
Minimally invasive surgery (MIS) and enhanced recovery programs have been increasingly adopted in colorectal surgery. The aim of this prospective observational study was to evaluate the usefulness of the C-reactive protein (CRP) concentration measured on postoperative day 3 (POD-3) as an early predictor of severe complications after minimally invasive colorectal resection.
From January 2014 to December 2015, 160 patients underwent resection of colorectal disease by MIS at the Division of General and Hepatobiliary Surgery, University of Verona Hospital Trust. Among these, CRP measurement was available on POD-3 in 143 patients.
Conversion from laparoscopic to open surgery was necessary in 18 patients (12.6%). The mean POD-3 CRP concentration was significantly higher in patients who did than did not require conversions (205.6 ± 89.6 mg/L versus 104.6 ± 85.8 mg/L, respectively; P < 0.001), even in the absence of postoperative complications, and these patients were therefore excluded from the subsequent analysis. No deaths occurred during the study period, but complications occurred in 39 patients (31.2%). Among these, 24 patients (61.5%) developed surgery-related complications. A POD-3 CRP concentration of 120 mg/L was highly reliable for excluding the occurrence of surgery-related and severe complications. The negative predictive values for excluding surgery-related and severe complications was 86.8% and 97.7%, respectively.
Assessment of the POD-3 CRP concentration after colorectal MIS is clinically significant for excluding the occurrence of surgery-related and severe complications. This measurement is a largely available, inexpensive, and easy-to-use tool that allows early and safe discharge in the setting of colorectal MIS and enhanced recovery programs.
微创外科手术（MIS）和加速康复计划已在结直肠手术中越来越多地被采用。这项前瞻性观察性研究的目的是评估术后第3天（POD-3）测量的C反应蛋白（CRP）浓度作为微创结直肠切除术后严重并发症早期预测指标的有效性。
2014年1月至2015年12月，160例患者在维罗纳大学医院信托基金普通和肝胆外科接受了MIS结直肠疾病切除术。其中，143例患者在POD-3时进行了CRP测量。
18例患者（12.6%）需要从腹腔镜手术转为开放手术。需要转为开放手术的患者POD-3时的平均CRP浓度显著高于不需要转为开放手术的患者（分别为205.6±89.6mg/L和104.6±85.8mg/L；P<0.001），即使在没有术后并发症的情况下也是如此，因此这些患者被排除在随后的分析之外。研究期间无死亡病例，但39例患者（31.2%）发生了并发症。其中，24例患者（61.5%）发生了与手术相关的并发症。POD-3时CRP浓度为120mg/L对于排除与手术相关的严重并发症的发生具有高度可靠性。排除与手术相关和严重并发症的阴性预测值分别为86.8%和97.7%。
结直肠MIS术后评估POD-3时的CRP浓度对于排除与手术相关的严重并发症的发生具有临床意义。该测量是一种广泛可用、廉价且易于使用的工具，可在结直肠MIS和加速康复计划中实现早期安全出院。
