Fernández-Candela Alba, Barber Xavier, López-Rodríguez-Arias Francisco, Lario-Pérez Sandra, Calero Alicia, Aranaz-Ostáriz Verónica, Caravaca-García Iban, Lillo-García Cristina, Sánchez-Guillén Luis, Lacueva Francisco-Javier
Department of General Surgery, Peritoneal Carcinomatosis Unit, Elche University General Hospital, Elche 03202, Valencia, Spain.
Joint Research Unit UMH-FISABIO, Center of Operations Research, Universidad Miguel Hernandez, Elche 03202, Valencia, Spain.
World J Gastrointest Surg. 2025 May 27;17(5):101323. doi: 10.4240/wjgs.v17.i5.101323.
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 0.5, 0.053 and 1.2 0.6, 0.049) and longer length of stay (19 14.9 days, 0.022 and 22.3 15.1 days, 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.
事实证明，无论是否进行热灌注化疗（HIPEC），大的术后并发症都是接受减瘤手术（CRS）患者长期生存的独立不良预后因素。C反应蛋白（CRP）是一种炎症标志物，据报道它是早期预测术后并发症的有用工具，中性粒细胞与淋巴细胞比值（NLR）也是如此。在腹膜癌患者中，术后第2至4天的CRP水平是CRS加HIPEC术后早期并发症的预测指标。
确定CRP和NLR在CRS±HIPEC术后早期检测总体术后感染（OPI）中的作用。
回顾性分析在一家三级医院接受腹膜癌治疗且实现了完全或最佳减瘤的患者。本研究共纳入111例患者。记录术前及术后前四天（POD）的CRP和NRL值以及免疫营养摄入情况。评估它们与术后第一周内OPI和腹腔内感染的相关性。
在纳入的111例患者中，19例出现OPI，8例出现腹腔内感染。感染患者的消化道吻合口数量多于未感染患者（分别为1±0.5，P = 0.053和1.2±0.6，P = 0.049），住院时间更长（分别为19±14.9天，P = 0.022和22.3±15.1天，P = 0.006）。术后第3天CRP值高于118 mg/L时，检测OPI的灵敏度为66.7%，特异度为74.2%。未观察到NLR值有差异。无论是否出现OPI，接受免疫营养摄入的患者CRP水平更高。随后，在术后第3天和第4天，无论免疫营养摄入情况如何，出现OPI的患者CRP水平均高于未感染患者。
CRP水平有助于检测接受CRS的腹膜癌患者的早期OPI。术后第3天118 mg/L的临界值具有最佳的灵敏度和特异度。
