Effect of High Postoperative Body Temperature on Long-Term Prognosis in Patients with Gastric Cancer After Radical Resection

Postoperative fever after elective minimally invasive resection for gastric and colorectal cancer: incidence, risk factors and characteristics

Purpose

To analyze the incidence and risk factors of postoperative fever (POF) in gastrointestinal cancer (GIC), discuss the influence of POF on short-term clinical outcomes, and predict anastomotic leakage (AL) based on POF characteristics.

Methods

Overall, 1362 patients that underwent radical resection for GIC were retrospectively analyzed. POF was defined as a postoperative temperature ≥38°C during hospitalization. Patients were divided according to whether they experienced POF. The influence of POF on short-term clinical outcomes was analyzed using propensity score matching. A subgroup analysis was conducted to examine the relationship between different POF characteristics and AL or infection-related complications.

Results

POF occurred in 172 patients (12.6%). Overall, 115 patients (66.9%) had fever ≥38.6°C, while 105 (61.0%) had fever at postoperative day (POD) 2, and 73 (42.4%) had POF multiple times. Multivariate analysis showed that patients with a preoperative albumin level < 37 g/L (odds ratio [OR]=1.57, p=0.016), operative time >195min (OR=1.55, p=0.020), and radical gastrectomy (OR=1.84, p=0.009) were more likely to develop POF. Compared to patients without fever, drainage tube indwelling time, duration of antibiotic use, and hospital stay were prolonged, while AL and infection-related complications were more common in patients with POF. POF ≥38.6°C (OR=1.74, p=0.039) and PCT >0.7 ng/mL (OR=2.99, p=0.022) at POD 3 were early predictors of AL.

Conclusion

POF was closely related to preoperative albumin levels, operative time, and type of operation, and it delayed postoperative recovery in patients with GIC. And POF ≥38.6°C and PCT >0.7 ng/mL at POD 3 were independent predictors of AL.

Experience sharing on perioperative clinical management of gastric cancer patients based on the "China Robotic Gastric Cancer Surgery Guidelines"

BACKGROUND

With the popularization of robotic surgical systems in the field of surgery, robotic gastric cancer surgery has also been fully applied and promoted in China. The Chinese Guidelines for Robotic Gastric Cancer Surgery was published in the Chinese Journal of General Surgery in August 2021.

METHODS

We have made a detailed interpretation of the process of robotic gastric cancer surgery regarding the indications, contraindications, perioperative preparation, surgical steps, complication, and postoperative management based on the recommendations of China's Guidelines for Robotic Gastric Cancer Surgery and supplemented by other surgical guidelines, consensus, and single-center experience.

RESULTS

Twenty experiences of perioperative clinical management of robotic gastric cancer surgery were described in detail.

CONCLUSION

We hope to bring some clinical reference values to the front-line clinicians in treating robotic gastric cancer surgery.

TRIAL REGISTRATION

The guidelines were registered on the International Practice Guideline Registration Platform ( http://www.guidelines-registry.cn ) (registration number: IPGRP-2020CN199).

Influence of Perioperative Anesthesia on Cancer Recurrence: from Basic Science to Clinical Practice

PURPOSEOF REVIEW

In this review, we will summarize the effects of these perioperative anesthetics and anesthetic interventions on the immune system and tumorigenesis as well as address the related clinical evidence on cancer-related mortality and recurrence.

RECENT FINDINGS

Cancer remains a leading cause of morbidity and mortality worldwide. For many solid tumors, surgery is one of the major therapies. Unfortunately, surgery promotes angiogenesis, shedding of circulating cancer cells, and suppresses immunity. Hence, the perioperative period has a close relationship with cancer metastases or recurrence. In the perioperative period, patients require multiple anesthetic management including anesthetics, anesthetic techniques, and body temperature control. Preclinical and retrospective studies have found that these anesthetic agents and interventions have complex effects on cancer outcomes. Therefore, well-planned, prospective, randomized controlled trials are required to explore the effects of different anesthetics and techniques on long-term outcomes after cancer surgery. Due to the conflicting effects of anesthetic management on cancer recurrence, further preclinical and clinical trials are required and beneficial to the development of systemic cancer therapies.