Changes in plasma albumin levels in early detection of infectious complications after laparoscopic colorectal cancer surgery with ERAS protocol

Abstract

Background: Combination of laparoscopic approach with ERAS protocol in colorectal surgery allows for an early discharge. However there is a risk that some of the discharged patients are developing, asymptomatic at the time, infectious complications. This may lead to a delay in diagnostics and proper treatment introduction. We aimed to assess the usefulness of preoperative plasma albumin concentration and their changes as indicators of infectious complications in patients undergoing colorectal cancer surgery.

Methods: Prospective analysis included 105 consecutive patients who underwent laparoscopic colorectal cancer resection between August 2014 and September 2016. In all cases standardised 16-item perioperative care ERAS protocol was used (mean compliance > 85%). Patients with IBD, distant metastases, undergoing emergency or multivisceral resection were excluded. Blood samples were collected preoperatively and on POD 1, 2, 3. Plasma albumin concentration was measured. Patients were divided into two groups depending on the presence of infectious complications. We analysed the differences in the levels of albumin and the dynamics of changes.

Results: Group 1-82 not complicated patients, Group 2-23 patients with at least one infectious complication. Preoperatively, there were no significant differences in the levels of serum albumin between those groups (Group 1-38.7 ± 4.9 g/l; Group 2-37.7 ± 5.0 g/l). In postoperative period, decrease was observed in both (POD 1: Group 1-36.5 ± 4.2 g/l, Group 2-34.7 ± 4.2 g/l, p = 0.07; POD 2: Group 1-36.2 ± 4.1 g/l, Group 2-32.6 ± 5.6 g/l, p = 0.01; POD 3: Group 1-36.0 ± 4.4 g/l, Group 2-30.9 ± 3.5 g/l, p = 0.01). The decrease was significantly greater in Group 2 on POD 2 and 3.

Conclusions: We showed that a regular measurement of albumin in the early postoperative days may be beneficial in the detection of postoperative infectious complications. Although changes in albumins are observed early after surgery, this parameter is relatively unspecific.

Keywords: Albumins; Colorectal cancer; Infectious complications; Laparoscopy; Markers.

Fig. 1

Patients flow through the study

Fig. 2

Mean albumin levels in Group 1 and Group 2 in consecutive days

Fig. 3

Mean Δ-albumin increments in Group 1 and Group 2 in consecutive days

Fig. 4

Albumin ratios in Group 1 and Group 2 in consecutive days

Fig. 5

Receiver operating characteristic (ROC) curve to determine the optimal cut-off of albumin measurements

Fig. 6

Receiver operating characteristic (ROC) curve to determine the optimal cut-off of Δ-albumin measurements

Fig. 7

Receiver operating characteristic (ROC) curve to determine the optimal cut-off of albumin ratio measurements (POD0)

Fig. 8

Receiver operating characteristic (ROC) curve to determine the optimal cut-off of albumin ratio measurements (POD1)