Peritoneal Surface Malignancies
Janyssa Charbonneau, MD (she/her/hers)
Surgical resident
Université Laval, Quebec, Canada
Janyssa Charbonneau, MD (she/her/hers)
Surgical resident
Université Laval, Quebec, Canada
Janyssa Charbonneau, MD (she/her/hers)
Surgical resident
Université Laval, Quebec, Canada
Mai-Kim Gervais, MD, FRCSC
Surgical Oncologist
Université de Montréal, United States
Alexandre Brind'Amour, MD, FRCSC
Hepato-Pancreatico-Biliary and Peritoneal Surface Malignancy Surgeon
Université Laval
Vancouver, British Columbia, United States
Guy Leblanc, MD, FRCSC
Surgical oncologist
Université de Montréal, United States
Lucas Sidéris, MD, FRCSC
Surgical oncologist
Université de Montréal, United States
Pierre Dubé, MD, FRCSC
Surgical oncologist
Université de Montréal, United States
Jean-François Tremblay, MD, FRCSC
Colorectal surgeon
Université de Montréal, United States
Mikaël Lefebvre Soucisse, MD, FRCSC
Surgical Oncologist
Université de Montréal, United States
Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with high morbidity rate and prolonged hospital stay. Diagnosis of infectious complications can be challenging because of patients’ immunosuppressed state and marked inflammatory response. C-reactive protein (CRP) measurement may be a helpful tool to detect postoperative complications. This study aimed to assess the predictive value of postoperative CRP levels for overall infectious complications and anastomotic leaks.
Methods: This is a single-center prospective study. Adult patients with peritoneal carcinomatosis arising from peritoneal mesothelioma, colorectal, appendiceal, gastric, endometrial, or ovarian cancer, and undergoing CRS with HIPEC were eligible. CRP serum levels were measured daily for the first ten postoperative days. Patients with (INF) and without (N-INF) infectious complications were compared. Anastomotic leaks were specifically studied.
Results:
99 CRS with HIPEC were performed between 2018 and 2020. The infectious complications rate was 30.3%. CRP levels were significantly higher with infectious complications, from postoperative day 2 to 10. Daily cut-off values predicted infectious complications most accurately on day 8 (CRP 94.3mg/L, AUD0.85, SE 76.2%, SP 94.7%, PPV 88.9%, NPV 87.8%, p< 0.0001) and day 9 (CRP 72.7mg/L, AUD0.89, SE 95.2%, SP 81.8%, PPV 76.9%, NPV 96.4%, p < 0.0001). With higher NPVs, cut-off values are particularly reliable to rule out infectious complications.
Patients with infectious complications had longer operative time, higher peritoneal carcinomatosis index (PCI) and a higher number of intestinal anastomoses. Infectious complications were strongly associated with non-infectious ones (non-infectious complications rate among N-INF 30.4% vs. INF 66.7%, p=0.001). CRP levels were not specifically affected by the presence or absence of intestinal anastomosis, nor by HIPEC specific regimen. Although not statistically significant, a positive correlation was demonstrated between PCI and CRP levels. With only four cases of anastomotic leak, specific analyses could not be conducted.
Conclusions: CRP measurement may help predict infectious complications following CRS-HIPEC. Cut-off values are more accurate on postoperative day 8 and 9, especially to rule out infectious complications.