title: Postoperative time course and utility of inflammatory markers in patients with ovarian peritoneal carcinomatosis treated with neoadjuvant chemotherapy, cytoreductive surgery, and HIPEC.
abstract: BACKGROUND
  Inflammatory markers may help monitor postoperative evolution of surgical patients and detect complications. However, to date, the effect that neoadjuvant chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) may have in the postoperative kinetics of these parameters remains unknown.
  
  
  METHODS
  Between July 2011 and June 2014, all patients who underwent neoadjuvant chemotherapy, cytoreductive surgery, and HIPEC for ovarian peritoneal carcinomatosis were studied. Patients were divided into four groups: no complications, noninfective complication, and infective complications during the first and second postoperative weeks. Retrospectively, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), white blood cell count, platelet-to-lymphocyte ratio, and prothrombin ratio were collected from postoperative days 1-14. Postoperative behavior of each parameter was carefully evaluated across groups.
  
  
  RESULTS
  The study included 122 patients. Only CRP and NLR showed promising results. CRP presented a mean peak value at 48 h (186.1 mg/L), while NLR peaked at 24 h (10.21 mg/L). Both parameters rose with infective complications. Statistically significant differences were found at several time points compared with uncomplicated patients. A simple test comparing the peak value of CRP with the value when an infective complication was suspected accurately diagnosed these complications with sensitivity of 81 %, specificity of 91 %, and negative and positive predictive value of 93.1 and 76 %, respectively. This comparison presented lower diagnostic performance when NLR was used.
  
  
  CONCLUSIONS
  Both CRP and NLR are useful in monitoring postoperative evolution in these patients; however, only CRP is useful for detecting infective complications.
authors.affiliation: Department of General and Digestive Surgery, University Hospital Reina Sofía, Córdoba, Spain, mefef.dr@gmail.com.
authors.forename: F J
authors.initials: FJ
authors.lastname: Medina Fernández
authors.forename: F C
authors.initials: FC
authors.lastname: Muñoz-Casares
authors.forename: A
authors.initials: A
authors.lastname: Arjona-Sánchez
authors.forename: A
authors.initials: A
authors.lastname: Casado-Adam
authors.forename: I
authors.initials: I
authors.lastname: Gómez-Luque
authors.forename: D J
authors.initials: DJ
authors.lastname: Garcilazo Arismendi
authors.forename: H
authors.initials: H
authors.lastname: Thoelecke
authors.forename: S
authors.initials: S
authors.lastname: Rufián Peña
authors.forename: J
authors.initials: J
authors.lastname: Briceño Delgado
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002097:C-Reactive Protein; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D010478:Chemotherapy, Cancer, Regional Perfusion; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006979:Hyperthermia, Induced; D018836:Inflammation Mediators / Q000032:analysis*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D017239:Paclitaxel / Q000008:administration & dosage; D010534:Peritoneal Neoplasms / Q000378:metabolism / Q000473:pathology* / Q000628:therapy; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate
chemical_list: D018836:Inflammation Mediators; D002097:C-Reactive Protein; D016190:Carboplatin; D017239:Paclitaxel