The value of C-reactive protein ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

 FAN Hongxing , NI Jianxun , BO Biao , GAO Xian , FANG Qilou

Department of General Surgery, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, Liaoning 123000, P. R. China;

Corresponding author：

FAN Hongxing, Email: fhx328927865@163.com

Keywords：

gastric cancer; C-reactive protein ratio; postoperative complication; laparoscopic gastrectomy

DOI：

10.7507/1007-9424.202003141

Video：

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Objective To investigate the clinical value of the C-reactive protein (CRP) ratio (CRP value on postoperative day 3/day 1) as an early predictor of postoperative severe complication after laparoscopic gastrectomy (LG) for gastric cancer.Methods This retrospective study examined the relationship between the occurrence of severe complication and the CRP ratio of 259 gastric cancer patients, who underwent LG in the Department of General Surgery of General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group from January 2015 to January 2020. According to Clavien-Dindo (CD) grading system, gastric cancer patients were divided into the severe postoperative complication group (n=41, 15.8%) and the non-severe postoperative complication group (n=218, 84.2%). The relationship between CRP ratio and clinicopathologic characteristics of patients and the predictive value of CRP ratio for severe complication were analyzed.Results The optimal cutoff value of CRP ratio of 2.2 offered 63.2% sensitivity, 91.0% specificity, 70.7% positive predictive value, and 85.8% negative predictive value for severe postoperative complication. The area under the receiver operating characteristic curve was 0.766. There had distinct differences (P<0.05) on body mass index, preoperative comorbidity, type of surgery, T stage, and TNM stage between the high CRP ratio group (CRP ratio >2.2, n=60) and the low CRP ratio group (CRP ratio ≤2.2, n=199). Logistic regression showed that preoperative comorbidity [OR=3.624, 95%CI (1.191, 11.206), P=0.023], later of TNM stage [OR=9.037, 95% CI (1.729, 47.226), P=0.009], and CRP ratio >2.2 [OR=20.473, 95%CI (7.948, 52.737), P<0.001] were independent risk factors for postoperative severe complication after LG.Conclusion There must to be paid enough attention to the CRP ratio >2.2 on the day 1 and 3 after LG, it suggests that there might be a risk of severe postoperative complications.

Citation： FAN Hongxing, NI Jianxun, BO Biao, GAO Xian, FANG Qilou. The value of C-reactive protein ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(1): 67-72. doi: 10.7507/1007-9424.202003141 Copy

1.	Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
2.	Kuroda S, Kikuchi S, Hori N, et al. Training system for laparoscopy-assisted distal gastrectomy. Surg Today, 2017, 47(7): 802-809.
3.	Park YK, Yoon HM, Kim YW, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase Ⅱ multicenter clinical trial (COACT 1001). Ann Surg, 2018, 267(4): 638-645.
4.	Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage Ⅰ gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg, 2016, 263(1): 28-35.
5.	孙益红, 方勇. 胃癌根治术后吻合口相关并发症的发生原因及防治要点. 中华胃肠外科杂志, 2017, 20(2): 144-147.
6.	黄昌明, 王家镔. 腹腔镜胃癌根治术的并发症及防治. 中国普外基础与临床杂志, 2019, 26(7): 775-778.
7.	Nozoe T, Kono M, Hashimoto N, et al. Definition of prognosis based on lymph node metastasis and elevation of serum C-reactive protein for patients with gastric carcinoma treated with curative resection. J Med Invest, 2018, 65(3.4): 191-194.
8.	Ito Y, Kanda M, Ito S, et al. Intraoperative blood loss is associated with shortened postoperative survival of patients with stage Ⅱ/Ⅲ gastric cancer: analysis of a multi-institutional dataset. World J Surg, 2019, 43(3): 870-877.
9.	刘凤林, 秦新裕. 胃癌根治术现状与展望. 中国普外基础与临床杂志, 2019, 26(7): 769-771.
10.	Shishido Y, Fujitani K, Yamamoto K, et al. C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection. Gastric Cancer, 2016, 19(1): 293-301.
11.	Matsunaga T, Saito H, Murakami Y, et al. Serum level of C-reactive protein on postoperative day 3 is a predictive indicator of postoperative pancreatic fistula after laparoscopic gastrectomy for gastric cancer. Asian J Endosc Surg, 2017, 10(4): 382-387.
12.	Kim EY, Yim HW, Park CH, et al. C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer. Surg Endosc, 2017, 31(1): 445-454.
13.	Saito T, Kurokawa Y, Miyazaki Y, et al. Which is a more reliable indicator of survival after gastric cancer surgery: postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol, 2015, 112(8): 894-899.
14.	Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
15.	陈杰, 李政焰, 季刚, 等. 腹腔镜与开腹胃癌根治术后并发症的 Clavien-Dindo 分级及危险因素分析. 腹部外科, 2020, 33(1): 34-41.
16.	徐卫国, 徐华, 马君俊, 等. 腹腔镜辅助胃癌根治术后并发症的 Clavien-Dindo 分级及危险因素分析. 中华消化外科杂志, 2016, 15(3): 228-233.
17.	林和新, 燕速, 叶志坚, 等. 体型对腹腔镜远端胃癌根治术后近期疗效的多中心回顾性研究 (附 506 例报告). 中华消化外科杂志, 2019, 18(1): 65-73.
18.	郗洪庆, 蓝炘, 张珂诚, 等. 腹腔镜辅助远端胃癌根治术后并发症发生的危险因素分析. 中华消化外科杂志, 2018, 17(2): 182-187.
19.	Shimoike N, Akagawa S, Yagi D, et al. Laparoscopic gastrectomy with and without prophylactic drains in gastric cancer: a propensity score-matched analysis. World J Surg Oncol, 2019, 17(1): 144-153.
20.	Takagi K, Domagala P, Polak WG, et al. Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. BMC Surg, 2019, 19(1): 129-142.
21.	Hamakawa T, Kurokawa Y, Mikami J, et al. Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities. Surg Today, 2016, 46(2): 224-228.
22.	马俊文, 马文, 韩瑞东. 腹腔镜辅助胃癌根治术的临床应用效果及对患者血清学指标的影响. 中国普通外科杂志, 2018, 27(4): 518-522.
23.	Powell AGMT, Parkinson D, Patel N, et al. Prognostic significance of serum inflammatory markers in gastric cancer. J Gastrointest Surg, 2018, 22(4): 595-605.
24.	Lee SH, Kim KH, Choi CW, et al. Reduction rate of C-reactive protein as an early predictor of postoperative complications and a reliable discharge indicator after gastrectomy for gastric cancer. Ann Surg Treat Res, 2019, 97(2): 65-73.
25.	Tanaka H, Tamura T, Toyokawa T, et al. C-reactive protein elevation ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer: a retrospective study. BMC Surg, 2019, 19(1): 114.
26.	Kostakis ID, Alexandrou A, Armeni E, et al. Comparison between minimally invasive and open gastrectomy for gastric cancer in Europe: a systematic review and meta-analysis. Scand J Surg, 2017, 106(1): 3-20.
27.	Straatman J, Cuesta MA, Tuynman JB, et al. C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial. Surg Endosc, 2018, 32(6): 2877-2885.
28.	程康文, 王贵和, 束宽山, 等. 加速康复外科在腹腔镜辅助胃癌根治术中的应用及其对患者术后恢复、营养及应激的影响. 中国普通外科杂志, 2019, 28(10): 1228-1236.
29.	Asaoka R, Kawamura T, Makuuchi R, et al. Risk factors for 30-day hospital readmission after radical gastrectomy: a single-center retrospective study. Gastric Cancer, 2019, 22(2): 413-420.
30.	Pirozzolo G, Gisbertz SS, Castoro C, et al. Neutrophil-to-lymphocyte ratio as prognostic marker in esophageal cancer: a systematic review and meta-analysis. J Thorac Dis, 2019, 11(7): 3136-3145.
31.	Tamura T, Sakurai K, Nambara M, et al. Adverse effects of preoperative sarcopenia on postoperative complications of patients with gastric cancer. Anticancer Res, 2019, 39(2): 987-992.
32.	Zhou J, Hiki N, Mine S, et al. Role of prealbumin as a powerful and simple index for predicting postoperative complications after gastric cancer surgery. Ann Surg Oncol, 2017, 24(2): 510-517.
33.	Inaoka K, Kanda M, Uda H, et al. Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer. World J Gastroenterol, 2017, 23(14): 2519-2526.

1. Kitano S, Iso Y, Moriyama M, et al. Laparoscopy-assisted Billroth Ⅰ gastrectomy. Surg Laparosc Endosc, 1994, 4(2): 146-148.
2. Kuroda S, Kikuchi S, Hori N, et al. Training system for laparoscopy-assisted distal gastrectomy. Surg Today, 2017, 47(7): 802-809.
3. Park YK, Yoon HM, Kim YW, et al. Laparoscopy-assisted versus open D2 distal gastrectomy for advanced gastric cancer: results from a randomized phase Ⅱ multicenter clinical trial (COACT 1001). Ann Surg, 2018, 267(4): 638-645.
4. Kim W, Kim HH, Han SU, et al. Decreased morbidity of laparoscopic distal gastrectomy compared with open distal gastrectomy for stage Ⅰ gastric cancer: short-term outcomes from a multicenter randomized controlled trial (KLASS-01). Ann Surg, 2016, 263(1): 28-35.
5. 孙益红, 方勇. 胃癌根治术后吻合口相关并发症的发生原因及防治要点. 中华胃肠外科杂志, 2017, 20(2): 144-147.
6. 黄昌明, 王家镔. 腹腔镜胃癌根治术的并发症及防治. 中国普外基础与临床杂志, 2019, 26(7): 775-778.
7. Nozoe T, Kono M, Hashimoto N, et al. Definition of prognosis based on lymph node metastasis and elevation of serum C-reactive protein for patients with gastric carcinoma treated with curative resection. J Med Invest, 2018, 65(3.4): 191-194.
8. Ito Y, Kanda M, Ito S, et al. Intraoperative blood loss is associated with shortened postoperative survival of patients with stage Ⅱ/Ⅲ gastric cancer: analysis of a multi-institutional dataset. World J Surg, 2019, 43(3): 870-877.
9. 刘凤林, 秦新裕. 胃癌根治术现状与展望. 中国普外基础与临床杂志, 2019, 26(7): 769-771.
10. Shishido Y, Fujitani K, Yamamoto K, et al. C-reactive protein on postoperative day 3 as a predictor of infectious complications following gastric cancer resection. Gastric Cancer, 2016, 19(1): 293-301.
11. Matsunaga T, Saito H, Murakami Y, et al. Serum level of C-reactive protein on postoperative day 3 is a predictive indicator of postoperative pancreatic fistula after laparoscopic gastrectomy for gastric cancer. Asian J Endosc Surg, 2017, 10(4): 382-387.
12. Kim EY, Yim HW, Park CH, et al. C-reactive protein can be an early predictor of postoperative complications after gastrectomy for gastric cancer. Surg Endosc, 2017, 31(1): 445-454.
13. Saito T, Kurokawa Y, Miyazaki Y, et al. Which is a more reliable indicator of survival after gastric cancer surgery: postoperative complication occurrence or C-reactive protein elevation? J Surg Oncol, 2015, 112(8): 894-899.
14. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg, 2009, 250(2): 187-196.
15. 陈杰, 李政焰, 季刚, 等. 腹腔镜与开腹胃癌根治术后并发症的 Clavien-Dindo 分级及危险因素分析. 腹部外科, 2020, 33(1): 34-41.
16. 徐卫国, 徐华, 马君俊, 等. 腹腔镜辅助胃癌根治术后并发症的 Clavien-Dindo 分级及危险因素分析. 中华消化外科杂志, 2016, 15(3): 228-233.
17. 林和新, 燕速, 叶志坚, 等. 体型对腹腔镜远端胃癌根治术后近期疗效的多中心回顾性研究 (附 506 例报告). 中华消化外科杂志, 2019, 18(1): 65-73.
18. 郗洪庆, 蓝炘, 张珂诚, 等. 腹腔镜辅助远端胃癌根治术后并发症发生的危险因素分析. 中华消化外科杂志, 2018, 17(2): 182-187.
19. Shimoike N, Akagawa S, Yagi D, et al. Laparoscopic gastrectomy with and without prophylactic drains in gastric cancer: a propensity score-matched analysis. World J Surg Oncol, 2019, 17(1): 144-153.
20. Takagi K, Domagala P, Polak WG, et al. Prognostic significance of the controlling nutritional status (CONUT) score in patients undergoing gastrectomy for gastric cancer: a systematic review and meta-analysis. BMC Surg, 2019, 19(1): 129-142.
21. Hamakawa T, Kurokawa Y, Mikami J, et al. Risk factors for postoperative complications after gastrectomy in gastric cancer patients with comorbidities. Surg Today, 2016, 46(2): 224-228.
22. 马俊文, 马文, 韩瑞东. 腹腔镜辅助胃癌根治术的临床应用效果及对患者血清学指标的影响. 中国普通外科杂志, 2018, 27(4): 518-522.
23. Powell AGMT, Parkinson D, Patel N, et al. Prognostic significance of serum inflammatory markers in gastric cancer. J Gastrointest Surg, 2018, 22(4): 595-605.
24. Lee SH, Kim KH, Choi CW, et al. Reduction rate of C-reactive protein as an early predictor of postoperative complications and a reliable discharge indicator after gastrectomy for gastric cancer. Ann Surg Treat Res, 2019, 97(2): 65-73.
25. Tanaka H, Tamura T, Toyokawa T, et al. C-reactive protein elevation ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer: a retrospective study. BMC Surg, 2019, 19(1): 114.
26. Kostakis ID, Alexandrou A, Armeni E, et al. Comparison between minimally invasive and open gastrectomy for gastric cancer in Europe: a systematic review and meta-analysis. Scand J Surg, 2017, 106(1): 3-20.
27. Straatman J, Cuesta MA, Tuynman JB, et al. C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial. Surg Endosc, 2018, 32(6): 2877-2885.
28. 程康文, 王贵和, 束宽山, 等. 加速康复外科在腹腔镜辅助胃癌根治术中的应用及其对患者术后恢复、营养及应激的影响. 中国普通外科杂志, 2019, 28(10): 1228-1236.
29. Asaoka R, Kawamura T, Makuuchi R, et al. Risk factors for 30-day hospital readmission after radical gastrectomy: a single-center retrospective study. Gastric Cancer, 2019, 22(2): 413-420.
30. Pirozzolo G, Gisbertz SS, Castoro C, et al. Neutrophil-to-lymphocyte ratio as prognostic marker in esophageal cancer: a systematic review and meta-analysis. J Thorac Dis, 2019, 11(7): 3136-3145.
31. Tamura T, Sakurai K, Nambara M, et al. Adverse effects of preoperative sarcopenia on postoperative complications of patients with gastric cancer. Anticancer Res, 2019, 39(2): 987-992.
32. Zhou J, Hiki N, Mine S, et al. Role of prealbumin as a powerful and simple index for predicting postoperative complications after gastric cancer surgery. Ann Surg Oncol, 2017, 24(2): 510-517.
33. Inaoka K, Kanda M, Uda H, et al. Clinical utility of the platelet-lymphocyte ratio as a predictor of postoperative complications after radical gastrectomy for clinical T2-4 gastric cancer. World J Gastroenterol, 2017, 23(14): 2519-2526.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

The value of C-reactive protein ratio as an early predictor of postoperative severe complications after laparoscopic gastrectomy for gastric cancer

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