Skip to main content

Advertisement

SpringerLink
Log in

A Postoperative Systemic Inflammation Score Predicts Short- and Long-Term Outcomes in Patients Undergoing Surgery for Colorectal Cancer

  • Colorectal Cancer
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Following surgery, a significant proportion of patients develop postoperative complications that are associated with poorer long-term survival. Stereotypical markers of the systemic inflammatory response (SIR) have been shown to identify patients at increased risk of developing such complications. The aim of the present study was to examine the prognostic value of a postoperative systemic inflammation-based score in patients undergoing potentially curative surgery for colorectal cancer.

Methods

Patients with histologically proven colorectal cancer undergoing resection between 1999 and 2013 (n = 813) were grouped into two cohorts—a retrospective test cohort (n = 402) and a prospective validation cohort (n = 411). Patients were assessed for postoperative complications and had routine blood samples taken daily. The relationship between markers of the postoperative SIR and survival was examined using Cox regression analysis.

Results

In the test cohort, 87 patients developed an infective complication, while in the validation cohort, 106 patients developed an infective complication. In both cohorts, the postoperative SIR (C-reactive protein and albumin thresholds of >150 mg/L and <25 g/L, respectively) were associated with the development of infective complications (all p < 0.01). Using these thresholds, a scoring system [postoperative Glasgow prognostic score (poGPS)] was created, and on days 3 and 4 was associated with an incremental increase in the infective complication rate (all p < 0.001) and complication severity (p < 0.001). In the overall cohort, there were 175 cancer and 139 non-cancer deaths. The poGPS was also significantly associated with overall survival (p < 0.05).

Conclusions

The postoperative SIR, evidenced by the poGPS, was associated with increased complication rates and severity and a reduction in survival.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cancer Research UK. Key facts. 2014. http://www.cancerresearchuk.org/cancer-info/cancerstats/keyfacts/bowel-cancer/.

  2. Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan DC, Morrison DS. Contribution of surgical specialization to improved colorectal cancer survival. Br J Surg. 2013;100(10):1388–95.

    Article  CAS  PubMed  Google Scholar 

  3. Abramovitch R, Marikovsky M, Meir G, Neeman M. Stimulation of tumour growth by wound-derived growth factors. Br J Cancer. 1999;79(9-10):1392–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mynster T, Christensen IJ, Moesgaard F, Nielsen HJ. Effects of the combination of blood transfusion and postoperative infectious complications on prognosis after surgery for colorectal cancer. Danish RANX05 Colorectal Cancer Study Group. Br J Surg. 2000;87(11):1553–62.

    Article  CAS  PubMed  Google Scholar 

  5. Baum M, Demicheli R, Hrushesky W, Retsky M. Does surgery unfavourably perturb the “natural history” of early breast cancer by accelerating the appearance of distant metastases? Eur J Cancer. 2005;41(4):508–15.

    Article  PubMed  Google Scholar 

  6. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92(9):1150–4.

    Article  CAS  PubMed  Google Scholar 

  7. Retsky MW, Demicheli R, Hrushesky WJ, Baum M, Gukas ID. Dormancy and surgery-driven escape from dormancy help explain some clinical features of breast cancer. APMIS. 2008;116(7-8):730–41.

    Article  CAS  PubMed  Google Scholar 

  8. Brown SR, Mathew R, Keding A, Marshall HC, Brown JM, Jayne DG. The impact of postoperative complications on long-term quality of life after curative colorectal cancer surgery. Ann Surg. 2014;259(5):916–23.

    Article  PubMed  Google Scholar 

  9. Mirnezami A, Mirnezami R, Chandrakumaran K, Sasapu K, Sagar P, Finan P. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg. 2011;253(5):890–9.

    Article  PubMed  Google Scholar 

  10. Richards CH, Platt JJ, Anderson JH, McKee RF, Horgan PG, McMillan DC. The impact of perioperative risk, tumor pathology and surgical complications on disease recurrence following potentially curative resection of colorectal cancer. Ann Surg. 2011;254(1):83–9.

    Article  PubMed  Google Scholar 

  11. Pucher PH, Aggarwal R, Qurashi M, Darzi A. Meta-analysis of the effect of postoperative in-hospital morbidity on long-term patient survival. Br J Surg. 2014;101(12):1499–508.

    Article  CAS  PubMed  Google Scholar 

  12. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261(3):497–505.

    Article  PubMed  Google Scholar 

  13. Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339–46.

    Article  CAS  PubMed  Google Scholar 

  14. McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102(5):462–79.

    Article  CAS  PubMed  Google Scholar 

  15. McSorley ST, Watt DG, Horgan PG, McMillan DC. Postoperative systemic inflammatory response, complication severity, and survival following surgery for colorectal cancer. Ann Surg Oncol. 2016;23(9):2832–40.

    Article  PubMed  PubMed Central  Google Scholar 

  16. The Royal College of Pathologists. Dataset for colorectal cancer histopathology reports (3rd edition). 2014. https://www.rcpath.org/resourceLibrary/dataset-for-colorectal-cancer-histopathology-reports–3rd-edition-.html.

  17. McMillan DC. The systemic inflammation-based Glasgow prognostic score: a decade of experience in patients with cancer. Cancer Treat Rev. 2013;39(5):534–40.

    Article  PubMed  Google Scholar 

  18. Platt JJ, Ramanathan ML, Crosbie RA, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19(13):4168–77.

    Article  PubMed  Google Scholar 

  19. Ramanathan ML, Mackay G, Platt J, Horgan PG, McMillan DC. Impact of day 2 C-reactive protein on day 3 and 4 thresholds associated with infective complications following curative surgery for colorectal cancer. World J Surg. 2013;37(11):2705–10.

    Article  PubMed  Google Scholar 

  20. Salvans S, Mayol X, Alonso S, et al. Postoperative peritoneal infection enhances migration and invasion capacities of tumor cells in vitro: an insight into the association between anastomotic leak and recurrence after surgery for colorectal cancer. Ann Surg. 2014;260(5):939–44.

    Article  PubMed  Google Scholar 

  21. McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg. 2004;91(5):605–9.

    Article  CAS  PubMed  Google Scholar 

  22. Oliphant R, Horgan PG, Morrison DS, McMillan DC, West of Scotland Colorectal Cancer Managed Clinical Network. Validation of a modified clinical risk score to predict cancer-specific survival for stage II colon cancer. Cancer Med. 2015;4(1):84–9.

    Article  PubMed  Google Scholar 

  23. Oliphant R, Mansouri D, Nicholson GA, et al. Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival. Int J Colorectal Dis. 2014;29(5):591–8.

    Article  PubMed  Google Scholar 

  24. Malietzis G, Currie AC, Johns N, et al. Skeletal muscle changes after elective colorectal cancer resection: a longitudinal study. Ann Surg Oncol. 2016;23(8):2539–47.

    Article  PubMed  PubMed Central  Google Scholar 

  25. McSorley ST, Horgan PG, McMillan DC. The impact of preoperative corticosteroids on the systemic inflammatory response and postoperative complications following surgery for gastrointestinal cancer: a systematic review and meta-analysis. Crit Rev Oncol Hematol. 2016;101:139–50.

    Article  PubMed  Google Scholar 

  26. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157(2):362–80.

    Article  PubMed  Google Scholar 

  27. Klein M, Gogenur I, Rosenberg J. Postoperative use of non-steroidal anti-inflammatory drugs in patients with anastomotic leakage requiring reoperation after colorectal resection: cohort study based on prospective data. BMJ. 2012;345:e6166.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bhangu A, Singh P, Fitzgerald JE, Slesser A, Tekkis P. Postoperative nonsteroidal anti-inflammatory drugs and risk of anastomotic leak: meta-analysis of clinical and experimental studies. World J Surg. 2014;38(9):2247–57.

    Article  PubMed  Google Scholar 

  29. STARSurg Collaborative. Impact of postoperative non-steroidal anti-inflammatory drugs on adverse events after gastrointestinal surgery. Br J Surg. 2014;101(11):1413–23.

    Article  Google Scholar 

Download references

Funding

No sources of financial support were obtained for the writing of this paper.

Author information

Authors and Affiliations

  1. Academic Unit of Surgery, R2.06, School of Medicine, Glasgow Royal Infirmary, University of Glasgow, Glasgow, Scotland, UK

    David G. Watt MB ChB, Stephen T. McSorley MB ChB, James H. Park MB ChB, Paul G. Horgan PhD & Donald C. McMillan PhD

Authors
  1. David G. Watt MB ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen T. McSorley MB ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James H. Park MB ChB
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul G. Horgan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Donald C. McMillan PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David G. Watt MB ChB.

Ethics declarations

Disclosure

David G. Watt, Stephen T. McSorley, James H. Park, Paul G. Horgan, and Donald C. McMillan declare no conflicts of interest.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Watt, D.G., McSorley, S.T., Park, J.H. et al. A Postoperative Systemic Inflammation Score Predicts Short- and Long-Term Outcomes in Patients Undergoing Surgery for Colorectal Cancer. Ann Surg Oncol 24, 1100–1109 (2017). https://doi.org/10.1245/s10434-016-5659-4

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5659-4

Keywords

Search

Navigation