C-reactive protein adjusted for body mass index as a predictor of postoperative complications following laparoscopic gastrectomy for gastric cancer

Clinical benefits including the postoperative inflammatory status of robot-assisted distal gastrectomy for gastric cancer compared with laparoscopic distal gastrectomy in patients with obesity

This study aimed to clarify the clinical benefits of robot-assisted distal gastrectomy (RDG) versus laparoscopic distal gastrectomy (LDG) in patients with obesity.The analysis included 89 and 87 patients in LDG and RDG groups, respectively. The associations between body mass index (BMI) and surgical outcomes including postoperative inflammation were compared between LDG and RDG.Incidences of postoperative complications did not show a significant difference between LDG and RDG. The operating time and blood loss increased with BMI in the LDG group, whereas no such correlation was observed in the RDG group. While BMI and C-reactive protein (CRP) levels on postoperative day (POD) 3 showed a significant correlation in LDG (R = 0.393, p < 0.001), RDG did not show a correlation. In patients with BMI ≥ 25 (kg/m2), CRP on POD 3 was significantly lower in RDG than in LDG. Multivariate analysis for CRP on POD 3 in patients with BMI ≥ 25 identified RDG and operating time ≥ 360 min as independent associated factors (B = - 6.887; p = 0.003 and B = 6.068; p = 0.011).RDG was indicated to reduce blood loss and suppress the postoperative CRP elevation compared with LDG, particularly in patients with high BMI.

Suggested Flowchart Through Integrated C-Reactive Protein and White Blood Cell Count Analysis for Screening for Early Complications After Gastric Bypass: a Single-Center Retrospective Study

INTRODUCTION

Early leakage detection following bariatric procedures is crucial, but a standardized evaluation method is lacking. The aim was to validate the potential benefits of postoperative day 1 (POD1) C-reactive protein (CRP) levels and white blood cell (WBC) counts in distinguishing at-risk patients following Roux-en-Y gastric bypass (RYGB) while considering the impact of obesity-related chronic inflammation.

METHODS

Retrospective analysis of 261 consecutive patients aged 18-65 years with a body mass index (BMI) of 32.5-50 kg/m2 who underwent primary RYGB between 2017 and 2022. Sequential changes in CRP levels and WBC counts measured 48 h preoperatively and on POD1 morning were collected and compared between patients with/without complications and in patients without complications stratified by preoperative CRP levels.

RESULTS

Female patients and those with a higher BMI tended to have higher baseline CRP levels, which were positively related to postoperative CRP. Patients experiencing complications had higher WBC counts and a higher prevalence of WBC counts >14,000/μl (77.8% vs. 25.4%; p<0.001) than those without complications. Baseline CRP ≥ 0.3 mg/dl, a longer operative time, and blood loss >10 ml were significantly more common with WBC counts above 14,000/μl; a reasonable range of change in WBC count (∆WBC) derived from its positive correlation to postoperative WBC count (r=0.6695) may serve as a useful complementary indicator.

CONCLUSION

An individualized CRP threshold setting and integrated interpretation of the WBC count can be more appropriate than using static criteria for differentiating at-risk patients after RYGB. Further studies are needed to validate these findings and determine their generalizability.