Postoperative systemic inflammatory response, complication severity, and survival following surgery for colorectal cancer

McSorley, S. T. , Watt, D. G., Horgan, P. G. and McMillan, D. C. (2016) Postoperative systemic inflammatory response, complication severity, and survival following surgery for colorectal cancer. Annals of Surgical Oncology, 23(9), pp. 2832-2840. (doi: 10.1245/s10434-016-5204-5) (PMID:27016295) (PMCID:PMC4972846)

Abstract

Background: This study examined the relationship between the magnitude of the postoperative systemic inflammatory response (SIR), the severity of complications, and long-term outcomes following surgery for colorectal cancer. Methods: Data were recorded prospectively for patients undergoing potentially curative surgery for colorectal cancer in a single centre between 2008 and 2013. The magnitude of the SIR was measured using C-reactive protein (CRP). Complications were classified by Clavien-Dindo grade. The impact on disease specific and overall survival was assessed using univariate and multivariate Cox regression. Results: Of 377 patients included, the majority were male (55 %), older than age 65 years (68 %), with colonic (63 %) and node-negative disease (66 %). A total of 138 patients (37 %) had a complication, of which 26 (6 %) were Clavien-Dindo grade 3 or 4 severity. Complication severity was significantly associated with the established CRP thresholds of 150 mg/L on postoperative day (POD) 3 (p < 0.001) and POD 4 (p < 0.001). Median follow-up was 42 months with disease-specific survival 86 % and overall survival 78 %. On univariate analysis, complication severity [hazard ratio (HR) 1.66, 95 % confidence interval (CI) 1.13–2.43, p = 0.009], and POD 4 CRP > 150 mg/L (HR 2.53, 95 % CI 1.43–4.48, p = 0.001) were associated with disease-specific survival. On multivariate survival analysis, POD 4 CRP > 150 mg/L (HR 2.00, 95 % CI 1.12–3.59,p = 0.020), but not complication severity, was significantly associated with disease-specific survival independent of TNM stage (HR 2.46, 95 % CI 1.52–4.12, p < 0.001). Conclusions The magnitude of the postoperative SIR, evidenced by CRP, was significantly associated with long-term outcomes following surgery for colorectal cancer, independent of complications and stage.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Horgan, Professor Paul and McMillan, Professor Donald and Watt, Dr David and McSorley, Dr Stephen
• Authors: McSorley, S. T., Watt, D. G., Horgan, P. G., and McMillan, D. C.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Surgical Oncology
• Publisher: Springer-Verlag
• ISSN: 1068-9265
• ISSN (Online): 1534-4681
• Published Online: 25 March 2016
• Copyright Holders: Copyright © 2015 The Authors
• First Published: First published in Annals of Surgical Oncology 23(9): 2832-2840
• Publisher Policy: Reproduced under a creative commons license