The Impact of Open Versus Laparoscopic Resection for Colon Cancer on C-Reactive Protein Concentrations as a Predictor of Postoperative Infective Complications
The Impact of Open Versus Laparoscopic Resection for Colon Cancer on C-Reactive Protein Concentrations as a Predictor of Postoperative Infective Complications
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DOI：
10.1245/s10434-014-4065-z
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发表时间：
2015-03-01
影响因子：
3.7
通讯作者：
McMillan, Donald C.
中科院分区：
文献类型：
--
作者：
Ramanathan, Michelle L.;MacKay, Graham;McMillan, Donald C.
背景越来越多的证据表明，C反应蛋白是结直肠癌术后感染并发症和吻合口瘘的一个有用的阴性预测因子。特别是，术后第3天和第4天的C反应蛋白浓度已被提出具有临床实用性，因为它们有助于结直肠手术后选定患者的安全和早期出院。然而，目前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每日C-反应蛋白浓度在预测开腹与腹腔镜结肠癌切除术患者术后感染并发症中的价值。在格拉斯哥的两所大学教学医院之一接受了潜在治愈性切除的组织学证实的结肠癌患者被纳入本研究（n = 344）。在前瞻性手术数据库中收集患者特征。所有切除均为择期手术，采用开放手术（n = 191）或腹腔镜手术（n = 153）进行。每天例行采集血液样本，以测量围手术期C反应蛋白浓度。评估患者术后感染性和非感染性并发症。大多数患者年龄≥ 65岁（75%），男性（52%），左侧肿瘤（54%），淋巴结阴性疾病（77%），未接受新辅助治疗（94%）。接受开腹和腹腔镜切除术的患者在年龄、性别、肿瘤部位、TNM分期、合并症和感染并发症方面相似。相反，在整个队列中（n = 344;所有p < 0.001）和未发生感染并发症的患者中（n = 251;所有p <0.001），腹腔镜手术前和术后1-3天的C反应蛋白浓度低于开放手术。腹腔镜切除术的中位住院时间较短（p < 0.001）。随访期间，127例（37%）患者发生术后并发症，其中93例（73%）为感染并发症。在发生感染并发症的患者中，术后1-4天开放手术和腹腔镜手术的C反应蛋白浓度无显著差异。预测感染并发症的C反应蛋白阈值在开腹和腹腔镜结肠癌切除术后第3天（180 mg/l）和第4天（140 mg/l）相同。本研究的结果表明，虽然全身炎症反应的幅度，证明了C-反应蛋白，手术后开放相比腹腔镜切除术更大，C-反应蛋白的阈值浓度为术后感染并发症的发展是非常相似的第3和第4天。
Background. 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.Methods. 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.Results. 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.Conclusions. 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.