Predictive Value of Postoperative C-reactive Protein Ratio for Early Postoperative Complications After Laparoscopic Gastrectomy.

ABSTRACT

Context Laparoscopic gastrectomy (LG) provides advantages such as rapid postoperative recovery and little trauma, but postoperative complications are still unavoidable. Detecting serious complications after LG surgery is still a difficult problem for digestive surgeons. Objective: The study intended to evaluate the clinical significance of the C-reactive protein (CRP) ratio in predicting postoperative complications after LG. Design: The research team performed a retrospective analysis. Setting: The study took place at Department of General Surgery, Qingdao Clinical Medical College, Nanjing Medical University, Qingdao, China. Participants: Participants were 128 patients with gastric cancer, confirmed through histopathology, who underwent an LG in the general surgery department of the hospital between January 2015 and January 2020. Groups Based on the optimal cut-off value of the CRP ratio, the research team divided participants into two groups, with 30 participants with a CRP ratio of >2.0 in the high CRP-value group and 98 with a CRP ratio of ≤2.0 in the low CRP-value group. Also, based on the incidence of complications, the team divided participants into a second set of groups, with 30 participants in a severe complications group and 98 in a nonsevere complications group. Outcome Measures: The research team (1) determined participants' CRP ratios and compared the clinicopathological characteristics of the high and low CRP-value groups, (2) identified the postoperative complications that participants experienced and compared the clinicopathological characteristics of the severe and nonsevere complications groups, (3) analyzed the predictive value of the CRP levels for early complications after LG using a receiver operating characteristic (ROC) curve, and (4) performed a multivariate regression analysis to determine the risk factors for serious complications. Results: No significant differences existed between the two complication groups in CRP value, white-blood-cell (WBC) count, and WBC count ratio on days 1 and 3 after surgery (P > .05), but the severe complications group had a significantly higher CRP ratio than the nonsevere complications group did (P < .001). The ROC curve showed that the sensitivity, specificity, positive predictive value, and negative predictive value of CRP in predicting severe complications after LG were 67.19%, 84.38%, 73.28%, and 83.27%, respectively. Thank you for your suggestion, we have added tables for these data. Compared to the low CRP-ratio group, the high CRP-value group had (1) a significantly higher body mass index (BMI), with p=0.031; (2) was significantly more likely to have preoperative underlying diseases (P = .011); (3) was significantly more likely to have had a total gastrectomy (P = .006); (4) was significantly more likely to be in the T3+T4 stage (P = .034); (5) was significantly more likely to be in the tumor, node, metastasis (TNM) stage II or III (P = .010); and (6) was significantly more likely to have had postoperative severe complications (P < .001). The multivariate analysis found that the independent risk factors for severe complications after LG included (1) preoperative underlying diseases-OR=3.624, 95% CI (1.191, 11.206) and P = .023; (2) an advanced TNM stage [OR=9.037, 95% CI (1.729, 47.226), P = .009; and (3) a CRP ratio >2.2 [OR=20.473, 95% CI (7.948, 52.737), P < .001. Conclusions: The CRP ratio after LG can effectively predict postoperative complications that need treatment, and when the ratio is more than 2.2, digestive surgeons should pay attention to the possibility of serious complications.