Evaluation of the relationship between lactacidemia and postoperative complications after surgery for peritoneal carcinomatosis

Abstract

Background. Cytoreduction surgery has been developed as a treatment of peritoneal carcinomatosis. However, this surgery is associated with important complications. The present study attempts to assess the relationship between lactacidemia levels and the rate of associated complications in patients undergoing cytoreduction surgery during the immediate postoperative period in a critical unit. Methods. Retrospective observational study. 57 patients underwent cytoreduction surgery during the years 2014 and 2015 at the General University Hospital of Castellón. All patients were admitted to the critical unit immediately after surgery. Lactacidemia levels at the time of admission and discharge from the critical unit were collected. Post-surgical complications that appeared during the stay in the critical unit were recorded according to Failure-to-rescue analysis and their severity stratified according to the Clavien-Dindo classification. Results. The levels of lactic acid upon admission to the critical unit were significantly higher in those who suffered complications, with almost a tripled unadjusted relative risk (2.9; 95% CI: 1.6-5.3) with respect to those patients who did not suffer complications for the lactacidemia threshold established in the cumulative sum curves (CUSUM) graphs. After adjustment for confounding effects, relative risk was even higher (3.1; 95%CI: 1.8-3.6). Lactacidemia levels were still significantly higher in this group at the time of discharge from Intensive Care Unit. Conclusion. Serum lactate is a risk factor for postoperative complications in patients undergoing cytoreduction surgery in peritoneal carcinomatosis.

Transparency considerations for describing statistical analyses in research

“…The number (percentage) of the articles that received a score of 3 for the two items (parameters derived from statistical analysis methods and rationale for and details of statistical analysis methods) was 24 (77.4%) and 23 (74.2%), respectively. The studies by Lee et al [ 3 ] and Hervás et al [ 4 ] received scores of 2 for the “rationale for and details of the statistical analysis methods used” item because, although they stated that they used propensity score matching, no descriptions of the adjustment method, caliper value, or the ratio of pair-matching were found, which would significantly affect the results of the subsequent statistical analysis. Likewise, the papers by Lim et al [ 5 ] and Tamboli et al [ 6 ] reported performing statistical analyses without describing the rationale for and details of the statistical analysis methods used.…”

Clinical significance of serum lactate and lactate dehydrogenase levels for disease severity and clinical outcomes in patients with colorectal cancer admitted to the intensive care unit

“…For instance, Gruttadauria et al discovered a significant association between hyperlactatemia observed during the perioperative period of pancreatic cancer resection and a longer ICU stay [ 24 ]. Similarly, Hervás et al reported that a high LA level was a risk factor for postoperative complications in patients undergoing peritoneal cytoreductive surgery, resulting in an extended ICU length of stay [ 25 ]. LDH, which is the final enzyme in the lactate pathway and the end product of anaerobic glucose glycolysis, has also been identified as an independent risk factor in various types of cancer [ 26 ].…”

Targeting Oncometabolites in Peritoneal Cancers: Preclinical Insights and Therapeutic Strategies

“…Lactate is one of the metabolites from glucose metabolism that has been identified as an oncometabolite in many cancers. Elevated lactate levels in the serum have been associated with poor prognosis and postoperative complications in patients with peritoneal cancers [ 48 ]. Lactate not only provides energy for the cancer cells but also regulates the TME by promoting angiogenesis, immunosuppression, and ECM remodeling [ 38 ].…”