-Original-

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

Ryohei Nishiguchi, Takao Katsube, Takeshi Shimakawa, Shinichi Asaka, Kentaro Yamaguchi, Minoru Murayama, Masano Sagawa, Kotaro Kuhara, Takebumi Usui, Hajime Yokomizo, Seiji Ohigashi and Shunichi Shiozawa

Department of Surgery, Tokyo Women's Medical University Adachi Medical Center

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.

J Nippon Med Sch 2024; 91: 37-47

Keywords
C-reactive protein, gastric cancer, inflammatory response indicators, postoperative complications

Correspondence to
Ryohei Nishiguchi, Department of Surgery, Tokyo Women's Medical University Adachi Medical Center, 4-33-1 Kohoku, Adachi-ku, Tokyo 123-8558, Japan
ryohei.nishiguchi@twmu.ac.jp

Received, January 30, 2023
Accepted, May 22, 2023