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Title:
Early markers of infectious complications after laparoscopic colorectal cancer surgery
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Subject:
colorectal cancer ; ERAS protocol ; laparoscopy ; inflammatory markers ; infectious complications
Abstract:
Introduction Colorectal surgery (CS) has high rate of infectious complications. Laparoscopy, along with ERAS protocol leads to reduction of total complication and postoperative time of hospitalization. This poses a risk that some patients may develop infectious complications after the discharge. Aim To determine the utility of C-reactive protein (CRP), interleukine-6 (IL-6), procalcitonin (PCT), plasma amyloid protein A (SAA) and albumin as early markers of infectious complications in patients undergoing laparoscopic CS with ERAS protocol. Materials and methods Consecutive patients undergoing elective laparoscopic resections for colorectal cancer in the years 2014-2016. Venous blood was collected before the procedure and in the next three postoperative days (POD). Patients without complications were included into group 1. Patients with infectious complications were included into group 2. Analyses of changes in plasma protein concentrations (CRP, PCT, IL6, SAA and albumin) were performed. Results The levels of all analyzed proteins (CRP, PCT and IL-6) differ between groups in 1-POD. The best single marker is IL-6 in 2-POD (cut-off value(cv) 78,04 ng/ml). For CRP and PCT measurements, best parameters were found to be obtained in 3-POD. In the case of IL-6 measurements in the 2-POD and CRP with PCT in 3-POD, a negative result of two out of three tests defines a group with ; out infectious complications with 100% sensitivity and 81% specificity. CRP as well as SAA differ significantly between groups from 2-POD. Both tests achieve best parameters in 3-POD – SAA (cv 1190 mg/l ) CRP (cv 186 mg/l). ROC curve analysis did not reveal differences for CRP and SAA curves in all POD. Both groups differ in terms of albumin concentration from 2-POD. Test achieves best parameters in 3-POD (cv 32 g/l). In both groups a significant reduction of albumin levels was noticed in 1-POD, however, in the 1 group this level was stabilizing in next days, differently than in the group 2. Conclusions All analyzed markers are useful in detecting early infectious complications and can be considered as an useful tool in monitoring patients after laparoscopic CS. Most specific single marker was IL-6 in 2-POD.
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choroby układu trawiennego ; onkologia ; chirurgia