The ratio of serum C-reactive protein level on postoperative day 3 to day 2 is a good marker to predict postoperative complications after laparoscopic radical gastrectomy for gastric cancer

Diagnostic Value of Postsurgical Endoscopy

Background

In the last 3 decades, we have witnessed a significant shift from traditional surgical approaches to minimally invasive and robotic surgery for treating gastrointestinal (GI) conditions minimalizing the associated morbidity and mortality. Meanwhile, endoscopy has continually evolved, reshaping the landscape of both diagnostic and therapeutic procedures. The implementation of postsurgical endoscopy as a critical diagnostic tool is primarily due to its capabilities in early complication detection and providing a prompt therapy possibility, assessment of healing, management of symptoms, and surveillance for recurrence in malignancy cases.

Summary

This review will first delve into the history of endoscopic developments, explore the various available postoperative diagnostic tools, focusing particularly on endoscopy and showing some real-life examples.

Key Messages

As an essential diagnostic tool, postsurgical endoscopy plays a crucial role in the management of patients undergoing upper and lower GI surgeries. It is indispensable for ensuring an optimal postoperative result. The continuous advancements in endoscopic technology and techniques have significantly enhanced the diagnostic and therapeutic capabilities of this modality, solidifying its role in modern GI surgery. Integrating postsurgical endoscopy into routine clinical practice and learning curriculum for surgical residents is vital and essential for optimizing the postoperative care to ensure the best possible outcome for patients.

Evaluation of C-reactive protein levels in patients with penile cancer: a systematic review and meta-analysis

BACKGROUND

C-reactive protein (CRP) is an essential biomarker for evaluating penile cancer prognosis. Previous studies have reported conflicting outcomes concerning the correlation between CRP levels and penile cancer prognosis. This study aimed to investigate this relationship by conducting a meta-analysis of published literature.

METHODS

A systematic literature search was conducted using the Cochrane Library, PubMed, and Embase databases to analyze the prognostic significance of serum CRP levels in individuals diagnosed with penile cancer. Pooled risk estimates were calculated using fixed-effects or random-effects models, depending on the degree of interstudy heterogeneity.

RESULTS

Sixty-eight articles were reviewed, identifying 8 articles and 989 patients that met the inclusion criteria for the meta-analysis. The pooled analysis revealed a significant association between serum CRP levels and adverse outcomes in penile cancer cases (hazard ratio [HR] = 2.37, 95% confidence interval [CI] = 1.46-3.858). Additional meta-analysis findings showed a negative correlation between elevated CRP levels and overall survival (HR = 1.97, 95% CI = 1.23-3.16, p<0.01), cancer-specific survival (HR = 3.42, 95% CI = 1.38-8.47, p<0.01), and disease-specific survival (HR = 3.23, 95% CI = 1.79-5.8, p<0.01) in patients with penile cancer. In the subgroup analysis, the HRs (95% CI) were 1.66 (0.61-4.48) in Europeans, 3.08 (2-4.74) in Asians, 3.04 (1.93-4. 77) in Chinese, 2.07 (1.21-3.53) in the group of cutoff value ≥ 5 mg/L, 2.43 (1.44-4.12) in the group of cutoff value ≥ 10 mg/L, 2.12 (1.04-4.32) in the group of surgical intervention, and 3.07 (1.76-5.37) in the group of multitherapy. This study also found a significant relationship between serum CRP levels and lymph node metastasis in patients with penile cancer (relative risk = 2.27, 95% CI = 1.61-3.2, p<0.01).

CONCLUSION

This meta-analysis indicates that increased CRP levels were associated with a poorer prognosis in penile cancer. Therefore, CRP levels could potentially serve as a prognostic indicator of penile cancer.

Prognostic Value of Inflammatory Burden Index in Advanced Gastric Cancer Patients Undergoing Multimodal Treatment

Since increasing evidence underlines the prominent role of systemic inflammation in carcinogenesis, the inflammation burden index (IBI) has emerged as a promising biomarker to estimate survival outcomes among cancer patients. The IBI has only been validated in Eastern gastric cancer (GC) patients; therefore, the aim of this study was to evaluate the IBI as a prognostic biomarker in Central European GC patients undergoing multimodal treatment. Ninety-three patients with histologically confirmed GC who underwent multimodal treatment between 2013 and 2021 were included. Patient recruitment started with the standardization of neoadjuvant chemotherapy (NAC). Blood samples were obtained one day prior to surgical treatment. The textbook outcome (TO) served as the measure of surgical quality, and tumor responses to NAC were evaluated according to Becker's system tumor regression grade (TRG). A high IBI was associated with an increased risk of postoperative complications (OR 2.95, 95% CI 1.13-7.72). In multivariate analysis, a high IBI (HR = 2.56, 95% CI 1.28-5.13) and a high neutrophil-to-lymphocyte ratio (NLR, HR = 2.55, 95% CI 1.32-4.94) were associated with an increased risk of death, while NAC administration (HR = 0.40, 95% CI 0.18-0.90) and TO achievement (HR = 0.42, 95% CI 0.22-0.81) were associated with a lower risk of death. The IBI was associated with postoperative complications and mortality among GC patients undergoing multimodal treatment.