title: C-Reactive Protein Indicates Early Stage of Postoperative Infectious Complications in Patients Following Minimally Invasive Esophagectomy.
abstract: Esophagectomy for patients with esophageal cancer is associated with high rate of postoperative infectious complications (PICs). Although minimally invasive esophagectomy (MIE) could reduce the rate of PICs, its incidence cannot be ignored. Early detection of PICs may be beneficial in clinical settings. We investigated whether systemic inflammation markers, such as C-reactive protein (CRP) and white blood cell count (WBC), are useful for the early detection of PICs.
  
  
  
  We reviewed 158 patients who underwent MIE from 2000 to 2015 and assessed PIC incidence and severity. The value of CRP and WBC in the early detection of PICs was evaluated by receiver operating characteristics analyses. Univariate and multivariate analyses were performed to identify severe PICs risk factors (Clavien-Dindo classification, grade IIIa or higher).
  
  
  
  Thirty patients developed PICs: grades III, IV, and V in 19 (12.0%), 9 (5.7%), and 2 (1.3%) patients, respectively. CRP on 4POD showed the highest value for detection of PICs (AUC = 072). Cutoff value of CRP on 4POD was determined as 11.1 (mg/dL), in which the sensitivity and specificity were the maximum value. The univariate analysis revealed that sex (male), operation time (≥597 min), and CRP on 4POD (≥11.1 mg/dL) were significant factors for detecting PICs. Multivariate analyses showed that operation time (≥597) and CRP on 4POD (≥11.1 mg/dL) were independent significant factors for detecting PICs.
  
  
  
  CRP on 4POD ≥11.1 mg/dL was an independent PICs risk factor in patients who underwent MIE. It will be beneficial for the early detection of PICs following MIE.
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Miki
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan. t-toyokawa@med.osaka-cu.ac.jp.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Toyokawa
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Naoshi
authors.initials: N
authors.lastname: Kubo
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Tatsuro
authors.initials: T
authors.lastname: Tamura
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Katsunobu
authors.initials: K
authors.lastname: Sakurai
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Tanaka
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Kazuya
authors.initials: K
authors.lastname: Muguruma
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yashiro
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Kosei
authors.initials: K
authors.lastname: Hirakawa
authors.affiliation: Department of Surgical Oncology, Osaka City University Graduate School of Medicine, 1-4-3, Asahimachi, Abeno-ku, Osaka City, Osaka, 545-8585, Japan.
authors.forename: Masaichi
authors.initials: M
authors.lastname: Ohira
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism*; D042241:Early Diagnosis; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007239:Infections / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects; D061646:Operative Time; D011183:Postoperative Complications / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D011184:Postoperative Period; D012372:ROC Curve; D012737:Sex Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein