title: Post-Operative Infection Is an Independent Risk Factor for Worse Long-Term Survival after Colorectal Cancer Surgery.
abstract: BACKGROUND
  Colorectal cancer surgery is associated with a high incidence of post-operative infections, the outcome of which may be improved if diagnosed and treated early enough. We compared white blood cell (WBC) count, C-reactive protein (CRP), and procalcitonin (PCT) as predictors of post-operative infections and analyzed their impact on long-term survival.
  
  
  METHODS
  This retrospective study included 186 patients undergoing colorectal surgery. Post-operative values of WBC, CRP, and PCT were analyzed by the receiver operating characteristic (ROC) analysis. We followed infections 30 d after the surgery. A five-year survival was analyzed by Kaplan-Meier method and prognostic factors by Cox regression model.
  
  
  RESULTS
  Fifty-five patients (29.5%) developed post-operative infection, the most frequent of which was surgical site infection (SSI). C-reactive protein on post-operative day three and PCT on post-operative day two demonstrated the highest diagnostic accuracy for infection (area under the curve [AUC] 0.739 and 0.735). C-reactive protein on post-operative day three was an independent predictor of infection. Five-year survival was higher in the non-infected group (70.8%), compared with the infected group (52.1%). The worst survival (40.9%) was identified in patients with organ/space SSI. Post-operative infection and tumor stage III-IV were independent predictors of a worse five-year survival.
  
  
  CONCLUSIONS
  C-reactive protein on post-operative day three and PCT on post-operative day two may be early predictors of infection after colorectal cancer surgery. Post-operative infections in particular organ/space SSI have a negative impact on long-term survival.
authors.affiliation: 1 Institute of Oncology , Ljubljana, Slovenia .
authors.forename: Milena
authors.initials: M
authors.lastname: Kerin Povšič
authors.affiliation: 2 Institute of Microbiology and Immunology, Ljubljana, Slovenia .
authors.forename: Alojz
authors.initials: A
authors.lastname: Ihan
authors.affiliation: 1 Institute of Oncology , Ljubljana, Slovenia .
authors.forename: Bojana
authors.initials: B
authors.lastname: Beovič
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000601:surgery*; D003107:Colorectal Surgery / Q000401:mortality*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000453:epidemiology*
chemical_list: D002097:C-Reactive Protein