Postoperative inflammatory response after laparoscopic radical hysterectomy in patients with early-stage cervical cancer

Abstract

Objectives: To investigate inflammatory responses after laparoscopic radical hysterectomy in Japanese women with early-stage cervical cancer.Methods: Clinical data of patients with early-stage cervical cancer treated with laparoscopic radical hysterectomy, between January 2013 and June 2018, were collected and retrospectively reviewed. The patients were classified into 2 groups: normal (patients without postoperative complications) and complication (patients who experienced postoperative complications) groups. Their postoperative leukocyte/neutrophil counts and C-reactive protein (CRP) levels (inflammatory markers) were evaluated. Finally, we investigated the clinical utilities of the inflammatory markers to predict postoperative complications using receiver-operating characteristic (ROC) analysis.Results: Fifty-three Japanese women underwent laparoscopic radical hysterectomy for early-stage cervical cancer.Postoperative complications occurred in 10 patients (18.9%). In the normal group, inflammatory markers peaked on postoperative day (POD) 1 and declined thereafter. Similarly, in the complication group, inflammatory markers peaked on POD 1 and declined on POD 3. However, they increased again thereafter, resulted in peaks on PODs 9-15. When the 2 groups were compared, inflammatory markers were significantly higher in the complication group than in the normal group. A leukocyte count >7280/μL, neutrophil count >6030/μL, or CRP level >0.4 mg/dL on POD 6 exhibited high sensitivities and specificities for the prediction of postoperative complications: leukocyte count (83.3%, 87.5%), neutrophil count (83.3%, 87.5%), or CRP level (100%, 56.3%), respectively. The negative predictive values of these markers were 93%, 93%, and 100%, respectively. Conclusion:Inflammatory responses after laparoscopic radical hysterectomy in Japanese women with early-stage cervical cancer were evaluated. Leukocyte/neutrophil counts or CRP levels on POD 6 are useful to predict postoperative complications, allowing for safe and early discharge.