内容紹介
The Postoperative C-Reactive Protein Level Is an Early Predictor of Infectious Complications after Gastric Cancer Resection
Summary
Aim: The aim of this study was to investigate whether postoperative serum C-reactive protein(CRP)levels can be used to predict the risk of postoperative infections in patients undergoing gastric cancer resection. Methods: Data from 77 patients who had undergone open gastrectomy for gastric cancer between 2008 and 2014 were retrospectively collected. Clinical details including postoperative white blood cell(WBC)count, CRP levels, and platelet(Plt)counts were obtained. The occurrence of complications as defined by the Clavien-Dindo classification was the outcome, particularly anastomotic leakage or pancreatic fistula. The diagnostic accuracy was determined by measuring the area under the receiver operating characteristic(ROC)curve. Results: The overall incidence of anastomotic leakage or pancreatic fistula was 9.1%. Using CRP on POD 3 had superior diagnostic accuracy for anastomotic leakage or pancreatic fistula(area under the curve[AUC]: 0.898, 95%CI: 0.809-0.987). A cut off of 20.1 mg/dL for the CRP level on POD 3 yielded a sensitivity of 85.7% and a negative predictive value of 98.3% for the detection of anastomotic leakage or pancreatic fistula. Conclusions: Elevated CRP levels on POD 3 may help physicians predict the occurrence of postoperative complications after gastric cancer resection, particularly anastomotic leakage and pancreatic fistula.
要旨
目的: 胃癌術後合併症発生の早期予測におけるC反応性蛋白(CRP)値の有用性を検討した。対象と方法: 当院で2008～2014年までの間に,胃癌に対して開腹幽門側胃切除術もしくは胃全摘術を施行した77例を対象とした。術後縫合不全もしくは膵液漏の合併群(C群)と非合併群(N群)に分類し,術後1日目,3日目,7日目の白血球数(WBC),CRP,血小板数(Plt)を比較した。さらに,ROC曲線を用いて術後縫合不全もしくは膵液漏の合併を予測する上で有用な項目を検討した。結果: 77例中7例で術後縫合不全(4例)もしくは膵液漏(3例)を合併した。術後3日目のCRP値,3日目と7日目の平均WBC値はC群で有意に高値であった(p<0.05)。術後3日目の平均CRP値のROC曲線下面積は0.898(95%CI: 0.809-0.987)と高値であった。cut off値は20.1 mg/dLで,感度85.7%,特異度84.3%であった。結語: 術後3日目のCRP値上昇は,術後合併症予測において有用と思われる。
目次
Summary
Aim: The aim of this study was to investigate whether postoperative serum C-reactive protein(CRP)levels can be used to predict the risk of postoperative infections in patients undergoing gastric cancer resection. Methods: Data from 77 patients who had undergone open gastrectomy for gastric cancer between 2008 and 2014 were retrospectively collected. Clinical details including postoperative white blood cell(WBC)count, CRP levels, and platelet(Plt)counts were obtained. The occurrence of complications as defined by the Clavien-Dindo classification was the outcome, particularly anastomotic leakage or pancreatic fistula. The diagnostic accuracy was determined by measuring the area under the receiver operating characteristic(ROC)curve. Results: The overall incidence of anastomotic leakage or pancreatic fistula was 9.1%. Using CRP on POD 3 had superior diagnostic accuracy for anastomotic leakage or pancreatic fistula(area under the curve[AUC]: 0.898, 95%CI: 0.809-0.987). A cut off of 20.1 mg/dL for the CRP level on POD 3 yielded a sensitivity of 85.7% and a negative predictive value of 98.3% for the detection of anastomotic leakage or pancreatic fistula. Conclusions: Elevated CRP levels on POD 3 may help physicians predict the occurrence of postoperative complications after gastric cancer resection, particularly anastomotic leakage and pancreatic fistula.
要旨
目的: 胃癌術後合併症発生の早期予測におけるC反応性蛋白(CRP)値の有用性を検討した。対象と方法: 当院で2008～2014年までの間に,胃癌に対して開腹幽門側胃切除術もしくは胃全摘術を施行した77例を対象とした。術後縫合不全もしくは膵液漏の合併群(C群)と非合併群(N群)に分類し,術後1日目,3日目,7日目の白血球数(WBC),CRP,血小板数(Plt)を比較した。さらに,ROC曲線を用いて術後縫合不全もしくは膵液漏の合併を予測する上で有用な項目を検討した。結果: 77例中7例で術後縫合不全(4例)もしくは膵液漏(3例)を合併した。術後3日目のCRP値,3日目と7日目の平均WBC値はC群で有意に高値であった(p<0.05)。術後3日目の平均CRP値のROC曲線下面積は0.898(95%CI: 0.809-0.987)と高値であった。cut off値は20.1 mg/dLで,感度85.7%,特異度84.3%であった。結語: 術後3日目のCRP値上昇は,術後合併症予測において有用と思われる。