title: Postoperative Systemic Inflammatory Response, Complication Severity, and Survival Following Surgery for Colorectal Cancer.
abstract: This study examined the relationship between the magnitude of the postoperative systemic inflammatory response (SIR), the severity of complications, and long-term outcomes following surgery for colorectal cancer.
  
  
  
  Data were recorded prospectively for patients undergoing potentially curative surgery for colorectal cancer in a single centre between 2008 and 2013. The magnitude of the SIR was measured using C-reactive protein (CRP). Complications were classified by Clavien-Dindo grade. The impact on disease specific and overall survival was assessed using univariate and multivariate Cox regression.
  
  
  
  Of 377 patients included, the majority were male (55 %), older than age 65 years (68 %), with colonic (63 %) and node-negative disease (66 %). A total of 138 patients (37 %) had a complication, of which 26 (6 %) were Clavien-Dindo grade 3 or 4 severity. Complication severity was significantly associated with the established CRP thresholds of 150 mg/L on postoperative day (POD) 3 (p < 0.001) and POD 4 (p < 0.001). Median follow-up was 42 months with disease-specific survival 86 % and overall survival 78 %. On univariate analysis, complication severity [hazard ratio (HR) 1.66, 95 % confidence interval (CI) 1.13-2.43, p = 0.009], and POD 4 CRP > 150 mg/L (HR 2.53, 95 % CI 1.43-4.48, p = 0.001) were associated with disease-specific survival. On multivariate survival analysis, POD 4 CRP > 150 mg/L (HR 2.00, 95 % CI 1.12-3.59, p = 0.020), but not complication severity, was significantly associated with disease-specific survival independent of TNM stage (HR 2.46, 95 % CI 1.52-4.12, p < 0.001).
  
  
  
  The magnitude of the postoperative SIR, evidenced by CRP, was significantly associated with long-term outcomes following surgery for colorectal cancer, independent of complications and stage.
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK. stephen.mcsorley@glasgow.ac.uk.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: McSorley
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: David G
authors.initials: DG
authors.lastname: Watt
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.affiliation: Academic Unit of Surgery, School of Medicine, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism*; D003110:Colonic Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011184:Postoperative Period; D012004:Rectal Neoplasms / Q000473:pathology / Q000601:surgery*; D012720:Severity of Illness Index; D012737:Sex Factors; D012907:Smoking; D015996:Survival Rate; D013997:Time Factors
chemical_list: D002097:C-Reactive Protein