The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study

Abstract

Background: Accurate prognostic biomarkers would substantially improve surgical planning and decisions making yet no studies have been reported exploring the inflammatory response in surgically treated older patients with cancer. The aim of this study was to explore inflammatory biomarkers as potential prognostic factors for postoperative complications within 30 days in older patients with cancer. Method: Patients 65 years and older undergoing surgery for removal of a solid malignant tumour were included in an observational cohort study. All complications occurring up to 30 days postoperatively were documented prospectively. Inflammatory markers were measured in plasma samples pre-and postoperatively: C-reactive protein (CRP), Interleukin-1 beta (IL-1β), IL-6, IL-10, IL-12, and Tumour necrosis factor-alpha (TNF-α). Associations between inflammatory markers and postoperative complications were explored using logistic regression analysis. Results: Between July 2010 and April 2014, plasma samples of 224 patients were collected. Median age was 72 (65-89) years and 116 (51.8%) patients were female. Approximately half of the patients developed postoperative complications (49.6%) of whom 62 patients (55.9%) developed N1 complication. An independent prognostic effect was observed for the inflammatory biomarkers IL-6 and IL-10 for the occurrence of postoperative complications. Conclusion:The perioperative inflammatory response is associated with complications, independently from patient and surgical factors which are also associated with outcome. Research is warranted towards further exploration of the perioperative inflammatory response with the aim to improve perioperative care and outcome, and might help to improve surgical planning and decision making for older patients with cancer.

Pre- and Perioperative Inflammatory Biomarkers in Older Patients Resected for Localized Colorectal Cancer: Associations with Complications and Prognosis

“…We also found that increases in IL-6 and YKL-40 during the first and second days following surgery were associated with major complications. An association between postoperative complications and the early increase in IL-6 on the first postoperative day [ 38 ] and immediately after surgery [ 39 ] has been demonstrated, but the association has not been investigated for YKL-40. The relationship between postoperative systemic inflammation and major complications is expected, since many complications have an inflammatory component (e.g., anastomotic leak) and other studies have shown that high CRP on postoperative days three and four is associated with anastomotic leak [ 38 , 40 , 41 ].…”

Oxidative Stress Predicts Post-Surgery Complications in Gastrointestinal Cancer Patients

“…Data for this observational cohort study were prospectively collected in the setting of an observational cohort study conducted in the University Medical Center Groningen (UMCG) as described elsewhere. 11,[32][33][34] Patients were included from April 2014 till October 2016 following a previously determined study protocol. Eligible for inclusions were all patients, aged 18 years and older, who received elective oncological surgery in the UMCG, regardless of the primary tumor.…”

“…Blood samples were handled as described previously. 33 All blood samples were directly centrifuged at 26009g for 10 min, after which they were stored at a minimum of -80 °C. All blood was analyzed for C-reactive protein (CRP) (lower limit of detection [LLD]: 0.001 lg/ml), interleukin-1b (IL-1b) (LLD: 1.27 pg/ml), IL-6 (LLD: 0.01 pg/ml), IL-10 (LLD: 3,28 pg/ml), IL-12 (LLD: 5.07 pg/ml), and tumor necrosis factor-alpha (TNF-a) (LLD: 6.49 pg/ml).…”

ASO Author Reflections: Oxidative Stress as a Predictor of Short-Term Outcome After Oncological Surgery for Gastrointestinal Cancer

“… 1 Formatting...Recently, systemic inflammation also has been found to be a predictor of complications, as evidenced by elevated levels of inflammatory cytokines, such as IL-6, IL-8, and IL-10. 2 …”