Teraishi Fuminori, Takahashi Ryusei, Okabayashi Hiroki, Utsumi Masashi, Miyaso Hideaki, Shoji Ryohei, Fujiwara Toshiyoshi, Mitsuhashi Toshiharu, Inagaki Masaru
Department of Surgery, NHO Fukuyama Medical Center, Hiroshima, 720-8520, Japan.
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Updates Surg. 2025 Aug 28. doi: 10.1007/s13304-025-02379-8.
This retrospective cohort study aimed to assess the predictive value of early postoperative C-reactive protein (CRP) levels for complications following robot-assisted rectal surgery (RARS) for rectal cancer. We analyzed data from 117 consecutive patients who underwent elective RARS at Okayama University Hospital between September 2020 and January 2025. Serum CRP levels were routinely measured preoperatively and on postoperative days (POD) 1 and 4. The primary outcome was the occurrence of any postoperative complication within 30 days, classified according to the Clavien-Dindo grading system. Postoperative complications were observed in 26 patients, representing 22.2% of the cohort. Univariate analysis revealed that several factors were significantly associated with complications, including older age, higher ASA score, neoadjuvant therapy, stoma creation, prolonged operative time, and elevated CRP levels on POD1 and POD4. Notably, multivariate logistic regression analysis identified POD1 CRP as a robust independent predictor of overall postoperative complications (adjusted odds ratio 0.77, 95% confidence interval (CI) [0.63-0.93], p < 0.01). In the ROC analysis, the AUC was 0.735 (bootstrap bias-corrected 95% CI 0.544-0.848). The optimal cutoff value of POD1 CRP was 5.63 mg/dl, at which Youden's index, yielding a sensitivity of 0.615 and specificity of 0.868. In conclusion, early postoperative measurement of CRP on POD1 serves as a valuable and independent biomarker for predicting complications following RARS for rectal cancer. Incorporating POD1 CRP into postoperative surveillance may facilitate the early identification of high-risk patients, thereby facilitating timely interventions and ultimately improving surgical outcomes in this patient population.
这项回顾性队列研究旨在评估直肠癌机器人辅助直肠手术（RARS）后早期C反应蛋白（CRP）水平对并发症的预测价值。我们分析了2020年9月至2025年1月在冈山大学医院连续接受择期RARS手术的117例患者的数据。术前及术后第1天和第4天常规检测血清CRP水平。主要结局是30天内发生的任何术后并发症，根据Clavien-Dindo分级系统进行分类。26例患者出现术后并发症，占队列的22.2%。单因素分析显示，几个因素与并发症显著相关，包括年龄较大、ASA评分较高、新辅助治疗、造口术、手术时间延长以及术后第1天和第4天CRP水平升高。值得注意的是，多因素逻辑回归分析确定术后第1天CRP是总体术后并发症的有力独立预测因素（调整后的优势比为0.77，95%置信区间[CI][0.63-0.93]，p<0.01）。在ROC分析中，AUC为0.735（自举偏差校正95%CI为0.544-0.848）。术后第1天CRP的最佳截断值为5.63mg/dl，此时约登指数的敏感性为0.615，特异性为0.868。总之，术后第1天早期测量CRP是预测直肠癌RARS术后并发症的有价值的独立生物标志物。将术后第1天CRP纳入术后监测可能有助于早期识别高危患者，从而促进及时干预并最终改善该患者群体的手术结局。
