Early postoperative (POD 2–4) CRP levels of patients treated for PCs from different origins by cytoreductive surgery and HIPEC predict postoperative infectious and non-infectious complications. Conversely, WBC and platelet counts are not predictive of postoperative complications in these patients.
The morbidity rate of patients treated with CRS and HIPEC for PC reported in the literature is around 30%-60% . Ours was around 70%, including the CD I rated complications. Our study showed as well a higher rate of postoperative complications in gastric cancer, pseudomyxoma peritonei and high PCIs, correlating with available literature data .
In practice, the diagnosis of early post-operative complications in patients who have undergone multiple intestinal resections and anastomoses, multiple organ resections, peritonectomies, or diaphragmatic resection is often difficult. A biological marker that could allow for earlier detection of complications, and thus, an earlier management of patients likely to develop postoperative complications, would be a very useful tool for improving the management of these patients.
CRP is a commonly used biological marker, being accurate, inexpensive, and easy to measure. CRP levels reflect the intensity of an inflammatory reaction, and CRP also participates in activating the inflammatory cascade . Recent studies have shown its efficacy for predicting postoperative complications, particularly in abdominal surgery [16, 21].
However, its usefulness in the setting of CRS combined with HIPEC has not been determined yet. To our knowledge, only one study has focused on the value of CRP for predicting postoperative complications of patients treated with CRS and HIPEC . Fernandez et al. showed that CRP levels at POD 2 were highly associated with postoperative early infectious complications in patients who underwent CRS plus HIPEC for PC of ovarian origin . However, they did not prove its significance in predicting non-infectious complications or late infectious ones.
In our study, we observed that CRP levels were higher in patients who developed postoperative complications whether infectious or not (Table I). Moreover, higher CRP levels reflected a higher complication grade (Table III). Also, we would like to emphasize that the early kinetics of CRP levels, rather than the actual CRP value, is more important. The sensitivity of detecting complications using CRP kinetics between POD 2 & 4 was 85%, with a specificity of 45%, PPV of 79%, and NPV of 57%. As shown in Fig. 1, the patients who were more prone to develop postoperative complications were those in whom CRP levels tended to rise and maintain a certain plateau between POD 2 and 4. No matter the actual peak in the CRP value, it was the persistent plateau that defined or predicted the imminent complication reflected by the mean at POD 2–4. The study of other inflammatory markers (WBC and platelets) on the occurrence of postoperative complications did not demonstrate any statistical significance between patients with and without complications.
One of the weaknesses of our study was its retrospective design. However, measurements for biological inflammatory markers (CRP, platelets, and WBCs) were performed in a systematic way and complications were reported in a prospective database. The major limitation related to the study design was that we evaluated a predictor of complications (CRP) over a shorter period of time (7 postoperative days) compared to the occurrence of the complications themselves (1 month). Despite this, the results remain highly significant because the majority of complications appeared in the course of the first postoperative week.