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ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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3/2018
vol. 13
 
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abstract:
Original paper

Use of inflammatory markers in the early detection of infectious complications after laparoscopic colorectal cancer surgery with the ERAS protocol

Mateusz Wierdak
,
Magdalena Pisarska
,
Beata Kuśnierz-Cabala
,
Michał Kisielewski
,
Piotr Major
,
Jan S. Witowski
,
Piotr Ceranowicz
,
Marcin Strzałka
,
Andrzej Budzyński
,
Michał Pędziwiatr

Videosurgery Miniinv 2018; 13 (3): 315–325
DOI: https://doi.org/10.5114/wiitm.2018.75846
Online publish date: 2018/05/16
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Introduction
Thanks to laparoscopy and enhanced recovery protocols (ERAS) it is possible to shorten hospitalization. Therefore, it seems reasonable to search for new early markers of infectious complications in order to select patients who are prone to development of complications.

Aim
To assess the usefulness of serum levels of C-reactive protein, interleukin-6 and procalcitonin as early indicators of infectious complications in patients after laparoscopic colorectal surgery with ERAS.

Material and methods
The prospective analysis included consecutive patients who underwent laparoscopic colorectal cancer resection. The following parameters were included in the analysis: C-reactive protein (CRP), interleukin 6 (IL-6) and procalcitonin measured on postoperative days (PODs) 1, 2, 3. Patients were divided into two groups: uncomplicated (group 1) and complicated (group 2). The difference in levels of the markers and the dynamics of changes observed in both groups were analyzed.

Results
Group 1 comprised 34 patients, and group 2 consisted of 17 patients. A significant increase of both absolute values and delta increments on all postoperative days was noted. ROC curve analysis showed that the best cut-off values indicating an infectious process were: CRP 129 mg/l on POD3 (92% sensitivity/80% specificity), IL-6 of 78 pg/ml on POD2 (91% sensitivity/97% specificity) and PCT 0.24 ng/ml on POD3 (93% sensitivity/68% specificity).

Conclusions
Our study showed that regular measurement of all analyzed markers in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Further studies are needed to fully assess the role of routine biochemical measurements in the postoperative period after laparoscopic surgery with the ERAS protocol.

keywords:

complications, laparoscopy, inflammatory markers, procalcitonin, colorectal surgery, enhanced recovery after surgery protocol
  
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