Predictive Postoperative Inflammatory Response Indicators of Infectious Complications Following Gastrectomy for Gastric Cancer

• Published in: Journal of Nippon Medical School Vol. 91; no. 1; pp. 37 - 47
• Main Authors: Nishiguchi, Ryohei, Katsube, Takao, Shimakawa, Takeshi, Asaka, Shinichi, Yamaguchi, Kentaro, Murayama, Minoru, Sagawa, Masano, Kuhara, Kotaro, Usui, Takebumi, Yokomizo, Hajime, Ohigashi, Seiji, Shiozawa, Shunichi
• Format: Journal Article
• Language: English; Japanese
• Published: Japan The Medical Association of Nippon Medical School 25.02.2024
• Subjects: Aged; C-reactive protein; C-Reactive Protein - analysis; Gastrectomy - adverse effects; gastric cancer; Humans; inflammatory response indicators; postoperative complications; Postoperative Complications - diagnosis; Postoperative Complications - etiology; Retrospective Studies; ROC Curve; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; postoperative complications; C-reactive protein; gastric cancer; inflammatory response indicators
• ISSN: 1345-4676; 1347-3409
• DOI: 10.1272/jnms.JNMS.2024_91-103

Background: Perioperative factors are useful for predicting postoperative infectious complications (PIC) in gastric cancer. Specifically, postoperative inflammatory response indicators (PIRI), [C-reactive protein (CRP) level, body temperature (BT), and white blood cell (WBC) count], are widely used in clinical practice. We investigated predictive factors for PIC, including PIRI, to establish a simple and practical indicator of postoperative complications after gastrectomy. Methods: We retrospectively collected clinical data from 200 patients with fStage I-III gastric cancer. Univariate/multivariate analysis was performed to evaluate the relationship of predictive factors [host factors, clinicopathological factors, and PIRI (BT, WBC count, and CRP level on postoperative day (POD) 1 and 3) ]. Cut-off values of the predictive factors were analyzed using receiver operating characteristic (ROC) curve modulated by the presence/absence of PIC Grade II, III (Clavien-Dindo classification). Results: Age [Odds ratio (OR): 5.67], smoking history (OR: 3.51), and CRP level (OR: 5.65), WBC count (OR: 8.96), and BT (OR: 3.37) on POD3 were selected as independent factors from multivariate analysis. Cut-off values were 77 years, 14.8 mg/dL, 116.0×102/μL, and 37.4°C, respectively. Conclusions: Predictive factors relative to PIC in gastric cancer were CRP level ≥ 14.8 mg/dL, WBC count ≥ 116.0×102/μL, and BT ≥ 37.4°C all on POD3. Age ≥ 77 years, and history of smoking were relative to PIC, suggesting a simple and practical indicator applicable in clinical practice.