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Serum procalcitonin improves diagnosis of infectious complications after CRS/HIPEC
Lilian Roth1, Dilmurodjon Eshmuminov1, Linda Russo1
1Surgical Oncology Research Laboratory, Department of Surgery & Transplantation, University Hospital of Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
Insights
Diagnosing infections after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) is challenging. Procalcitonin (PCT) aids in identifying infections, but clinical expertise remains crucial for diagnosis.
Area of Science:
- Oncology
- Surgical Oncology
- Critical Care Medicine
Background:
- Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are vital for patients with peritoneal metastasis.
- Infection and sepsis are significant causes of morbidity following CRS/HIPEC.
- HIPEC impacts the accuracy of standard blood markers for diagnosing postoperative complications.
Purpose of the Study:
- To evaluate the sensitivity and specificity of blood and serum markers for diagnosing postoperative complications after CRS/HIPEC.
- To determine the utility of white blood cell (WBC) counts, C-reactive protein (CRP), and procalcitonin (PCT) in this context.
Main Methods:
- Analysis of perioperative blood samples from 248 patients undergoing CRS/HIPEC across two centers (2009-2017).
- Measurement of WBC, CRP, and PCT levels.
- Grading of complications using Clavien-Dindo and CDC criteria.
Main Results:
- White blood cell (WBC) response to infection was suppressed in some patients post-HIPEC.
- C-reactive protein (CRP) showed non-specific elevations, particularly after prolonged HIPEC (>60 min).
- Procalcitonin (PCT) demonstrated high specificity, though lower sensitivity, for detecting infectious complications.
Conclusions:
- Standard markers like WBC counts and CRP have limited diagnostic value for infections after HIPEC.
- Procalcitonin (PCT) is a useful adjunct for specifying suspected infections.
- Postoperative complication diagnosis after CRS/HIPEC relies heavily on clinical assessment and surgical experience.
Background:
Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) improve the survival of selected patients with peritoneal metastasis. A major cause of treatment-related morbidity after CRS/HIPEC is infection and sepsis. HIPEC alters the diagnostic sensitivity and specificity of blood and serum markers and therefore has an impact on early diagnosis of postoperative complications. This study aimed to assess the sensitivity and specificity of blood and serum markers after CRS/HIPEC.
Methods:
Patients from two centers, operated between 2009 and 2017, were enrolled in this study. Perioperative blood samples were analyzed for white blood cells (WBC), C-reactive protein (CRP), and procalcitonin (PCT); postoperative complications were graded according to Clavien-Dindo and infectious complications according to CDC criteria.
Results:
Overall, n=248 patients were included with peritoneal metastasis from different primary tumors treated by CRS/HIPEC. Depending on the applied HIPEC protocol, patients presented a suppressed WBC response to infection. In addition, a secondary and unspecific CRP elevation in absence of an underlining infection, and pronounced after prolonged perfusion for more than 60 min. PCT was identified as a highly specific - although less sensitive - marker to diagnose infectious complications after CRS/HIPEC.
Discussion/Conclusion:
Sensitivity and specificity of WBC counts and CRP values to diagnose postoperative infection are limited in the context of HIPEC. PCT is helpful to specify suspected infection. Overall, diagnosis of postoperative complications remains a clinical diagnosis, requiring surgical expertise and experience.
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