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. 2025 Apr 7;29(1):97.
doi: 10.1007/s10151-025-03134-2.

Using inflammatory parameters for safe and early discharge after minimally invasive colorectal surgery for colorectal cancer

B D N Dos Santos  1 , C Beruti  2 , J Azevedo  1   3 , I Herrando  1 , P Vieira  1 , H Domingos  1 , R Heald  1 , L Fernandez  4 , A Parvaiz  1
Affiliations

Using inflammatory parameters for safe and early discharge after minimally invasive colorectal surgery for colorectal cancer

B D N Dos Santos et al. Tech Coloproctol. .

Abstract

Background: Minimally invasive surgery has become the gold standard for colorectal cancer treatment. Approximately 40% of patients undergoing elective colorectal resection develop postoperative complications. The median time to clinical diagnosis of a postoperative complication ranges between 5 and 8 days. Early detection of complications can reduce their morbidity and negative impact. This study aims to evaluate the effectiveness of routine postoperative inflammatory markers in predicting early postoperative complications in patients undergoing elective minimally invasive surgery for colorectal cancer.

Methods: This study was conducted at a single center and is a retrospective analysis of a prospectively mantained database. We included 397 consecutive patients who underwent elective minimally invasive surgery for colorectal cancer between May 2012 and September 2023. Routine inflammatory parameters, including C-reactive protein, Glasgow Prognostic Score, and neutrophil-lymphocyte ratio, were analyzed to identify those associated with postoperative complications. The cutoff values for these markers were determined using receiver-operating characteristic (ROC) curve analysis with the Youden index method.

Results: Of the patients, 29.2% experienced postoperative complications, with major complications (Clavien-Dindo ≥ III) occurring in 11.3%. On postoperative day 3, C-reactive protein level < 125 mg/L, Glasgow Prognostic Score < 2.12, and neutrophil-lymphocyte ratio < 5.26 were significantly associated with lower risk of postoperative complications (p < 0.0001). NLR was the best parameter to identify patients unlikely to experience a postoperative complication on day 3, with a cutoff value of 5.26 and a negative predictive value (NPV) of 83%.

Conclusions: Neutrophil-lymphocyte ratio, C-reactive protein, and Glasgow Prognostic Score on POD3 can predict postoperative complications in patients who undergoing minimally invasive surgery for colorectal cancer. These inflammatory markers demonstrated high negative predictive value, effectively identifying patients who are unlikely to develop complications and providing valuable information for safe early discharge.

Keywords: Colorectal cancer; Early discharge; Inflammatory markers; Minimally invasive surgery.

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Conflict of interest statement

Declarations. Conflict of interest: The authors declare no competing interests. Ethical and Informed Consent: The study was conducted in accordance with institutional ethical guidelines. All patients provided written informed consent for the use of their anonyized information in research purposes.

Figures

Fig. 1
Fig. 1
Flowchart of eligibility and exclusion criteria
See this image and copyright information in PMC

References

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