title: Preoperative C-reactive protein and operative blood loss predict poor prognosis in patients with gastric cancer after laparoscopy-assisted gastrectomy.
abstract: BACKGROUND
  The aim of this study was to clarify the factors associated with postoperative complications and prognoses following laparoscopy-assisted gastrectomy for gastric cancer.
  
  
  METHODS
  A total of 214 patients who underwent laparoscopy-assisted gastrectomy for gastric cancer were enrolled in this retrospective study. Factors that were potentially associated with postoperative complications and prognosis were assessed using the following clinical and perioperative parameters: the Estimation of Physiologic Ability and Surgical Stress scoring system, the Prognostic Nutritional Index, and the Clavien-Dindo classification.
  
  
  RESULTS
  Postoperative complications developed in 18.7% of patients. Blood loss ≥ 1% of body weight was significantly correlated with anastomotic leakage (P = 0.0108). Severe complications, based on the Clavien-Dindo classification, were more frequent in patients with proximal or total gastrectomies (P = 0.0324). A preoperative C-reactive protein level > 0.5 mg/dL, blood loss > 1% of body weight, age ≥ 70 years at the time of operation, and an Estimation of Physiologic Ability and Surgical Stress score ≥ 0.2 were significantly correlated with poor prognosis. Multivariate analysis revealed that two of these factors, preoperative C-reactive protein level ≥ 0.5 mg/dL and operative blood loss ≥ 1% of body weight, were independent prognostic factors (P = 0.0376 and P = 0.0112, respectively). The Prognostic Nutritional Index had no significant correlation with prognosis or the occurrence of postoperative complications.
  
  
  CONCLUSIONS
  Operative blood loss ≥ 1% of body weight and type of resection were associated with an increased frequency of postoperative complications, while preoperative C-reactive protein levels and operative blood loss may be prognostic predictors for gastric cancer patients following laparoscopy-assisted gastrectomy.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Yoshito
authors.initials: Y
authors.lastname: Ishino
authors.forename: Susumu
authors.initials: S
authors.lastname: Saigusa
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yasuda
authors.forename: Koji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Yuji
authors.initials: Y
authors.lastname: Toiyama
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Mohri
authors.forename: Masato
authors.initials: M
authors.lastname: Kusunoki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical; D002097:C-Reactive Protein / Q000378:metabolism*; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000097:blood / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: Laparoscopy-assisted gastrectomy; postoperative complication; prognosis