The effect of preoperative immunonutrition intake on postoperative major complications in patients following cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) was assessed. The accuracy of C-Reactive Protein (CRP) for detecting postoperative complications was also analyzed. Patients treated within a peritoneal carcinomatosis program in which a complete or optimal cytoreduction was achieved were retrospectively analyzed. They were divided into two groups based on whether preoperative immunonutrition (IMN) or not (non-IMN) were administered. Clinical and surgical variables and postoperative complications were gathered. Predictive values of major morbidity of CRP during the first 3 postoperative days (POD) were also evaluated. A total of 107 patients were included, 48 belonging to the IMN group and 59 to the non-IMN group. In multivariate analysis immunonutrition (OR 0.247; 95%CI 0.071–0.859; p = 0.028), and the number of visceral resections (OR 1.947; 95%CI 1.086–3.488; p = 0.025) emerged as independent factors associated with postoperative major morbidity. CRP values above 103 mg/L yielded a negative predictive value of 84%. Preoperative intake of immunonutrition was associated with a decrease of postoperative major morbidity and might be recommended to patients with peritoneal carcinomatosis following CRS. Measuring CRP levels during the 3 first postoperative days is useful to rule out major morbidity.

BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC). C-reactive protein (CRP) is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications, as is the neutrophil-to-lymphocyte ratio (NLR). In patients with peritoneal carcinomatosis, postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC. AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections (OPIs) after CRS +/- HIPEC. METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital, in whom complete or optimal cytoreduction was achieved, were analyzed retrospectively. A total of 111 patients were included in this study. CRP and NRL values prior to surgery and during the first four postoperative days (PODs) were recorded, along with immunonutrition intake. Their association with OPI and intra-abdominal infections during the first week after surgery was evaluated. RESULTS Of the 111 patients included, 19 presented OPI and 8 intra-abdominal infections. Patients with infections had a higher number of digestive anastomoses than those without (1 vs 0.5, P = 0.053 and 1.2 vs 0.6, P = 0.049) and longer length of stay (19 vs 14.9 days, P = 0.022 and 22.3 vs 15.1 days, P = 0.006). CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7% and a specificity of 74.2% to detect OPI. No differences in NLR values were observed. Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI. Subsequently, on POD3 and POD4, patients with OPI presented with higher levels of CRP than patients without infection, regardless of the immunonutrition intake. CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS. A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.