The importance of inflammatory markers in detection of complications in patients with gastric cancer undergoing the Enhanced Recovery After Surgery (ERAS) protocol: a prospective cohort study.

Abstract

Introduction: Early diagnosis reduces mortality and morbidity rates in gastrointestinal system (GIS) anastomoses. Aim:The aim of the present study was to investigate the importance of some substances that were used to detect major complications early in patients who were treated in line with the Enhanced Recovery After Surgery (ERAS) protocol for gastric cancer. Factors included in the study were , tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), procalcitonin (PCT) and white blood cell (WBC).Material and methods: A hundred and twenty patients who underwent laparoscopic subtotal or total gastrectomy for gastric cancer in accordance with the ERAS protocol between January 2018 and December 2019 were included in this prospective study. Blood values of IL-1β, TNF-α, CRP, PCT, and WBC on the third and fifth post-operative days (POD) were measured for diagnosing major complications. Results: Major complications occurred in 12 (10%) patients. Third POD and fifth POD measurements of IL-1β, TNF-α, CRP, PCT were statistically significantly higher than those in the non-complicated group, whereas WBC was not. In addition, in the group with complications, statistically significant changes of the blood levels of CRP, and PCT between the 3 rd and 5 th days were detected (p = 0.008, p = 0.001, p = 0.004, p = 0.001 respectively). Conclusions: IL-1β, TNF-α, CRP, and PCT can be used in the early detection of major complications in gastric cancer patients undergoing the ERAS protocol. Imaging methods should be used in patients with high levels of these inflammatory substances on the third and fifth POD.

A meta-analysis of randomized controlled trials comparing enteral immunonutrition (EIN) and standard enteral nutrition regarding biochemical, immunological, and clinical outcomes in gastrectomy patients with gastric cancer and investigating evidence networks for EIN formulae.

“…In our study, we applied a more extensive search strategy to investigate the effects of specific nutrient substances, including Arg, Gln, ω-3-FAs, and RNA, on the application of enhanced immunonutrition (EIN) compared to standard EN. Our findings indicate that EIN significantly enhances the post-operative levels of serum protein and immunological parameters, as shown by a significant standardized mean difference [51] presented findings indicating that timely identification of gastrointestinal system (GIS) anastomosis-related issues contributes to decreased mortality and morbidity rates. Additionally, the authors suggested that the supplementation of interleukin-1β (IL-1β), tumour necrosis factor-a (TNF-a), C-reactive protein (CRP), and procalcitonin (PCT) may serve as a viable approach for the early detection of significant issues in gastric cancer patients who are undergoing the Enhanced Recovery After Surgery (ERAS) protocol.…”

“…All the observed outcomes exhibited statistical significance ( p < 0.05), indicating a preference for the utilization of EIN in patients with gastric cancer who have gastrectomy, in comparison to EN. In their study, Gumusoglu et al (2022) [ 51 ] presented findings indicating that timely identification of gastrointestinal system (GIS) anastomosis-related issues contributes to decreased mortality and morbidity rates. Additionally, the authors suggested that the supplementation of interleukin-1β (IL-1β), tumour necrosis factor-α (TNF-α), C-reactive protein (CRP), and procalcitonin (PCT) may serve as a viable approach for the early detection of significant issues in gastric cancer patients who are undergoing the Enhanced Recovery After Surgery (ERAS) protocol.…”

“…All the observed outcomes exhibited statistical significance (p < 0.05), indicating a preference for the utilization of EIN in patients with gastric cancer who have gastrectomy, in comparison to EN. In their study,Gumusoglu et al (2022)…”

Laparoscopic vs open surgery for gastric cancer: Assessing time, recovery, complications, and markers

“…They mainly include proteins, enzymes, genes, antigens, and hormones produced by tumor cells or surrounding tissues, which can be detected in the blood, urine, tissue, and other body fluids[ 17 ]. Tumor markers have important clinical applications in many areas, such as early screening, diagnosis, efficacy monitoring, and prognosis evaluation[ 18 ]. CA19-9 is a glycoprotein tumor marker present in trace amounts or absent in healthy people.…”

Evaluation of enhanced recovery after surgery for gastric cancer patients undergoing gastrectomy: a systematic review and meta-analysis.

“…However, in a study by Gumusoglu et al [ 54 ] suggested that interleukin-1β (IL-1β), tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and procalcitonin (PCT) have demonstrated potential as biomarkers for the timely identification of significant complications in gastric cancer patients who are undergoing the ERAS protocol. Imaging modalities ought to be employed in individuals exhibiting elevated concentrations of these inflammatory biomarkers on the third and fifth postoperative day.…”