ABSTRACT
Aims : C-reactive protein (CRP) is commonly used for monitoring
Surgical Stress Response (SSR) and detecting post-operative infectious
complications. However, high CRP values can be associated to
patient-related factors independently from complications. The aim of
this study was to assess the relationship between visceral obesity (VO)
and SSR after laparoscopic colorectal resection.
Methods : Visceral adipose tissue (VAT) area was measured at CT
images for 357 patients who underwent elective laparoscopic colorectal
resection at our institution. Post-operative outcomes and CRP values
were compared between VO and non-VO groups, defined according to VAT
cut-offs. Univariate and multivariate analyses were conducted for
factors affecting SSR. ROC curves were constructed to assess the most
appropriate CRP values for identifying infectious complications in the
VO and non-VO populations.
Results : In the final cohort, 62.2% of patients were
classified as VO. No differences were seen in post-operative outcomes
and infectious complications. VO was associated with higher CRP values
on post-operative day (POD)1, POD2, POD3, and POD5, considering both the
overall cohort and patients without infectious complications. A positive
correlation was found between VAT and CRP values on all PODs, and VO
independently predicted increased CRP on POD1-3 in patients without
infectious complications but not in those who developed complications.
ROC curves analysis for POD3 CRP showed comparable accuracy for
detection of infectious complications in both groups, though the optimal
cut-off value was higher in VO group (154 vs. 136 mg/dl).
Conclusions : Although VO is not associated to increased
complications after laparoscopic colorectal resection, it independently
predicts increased SSR risk. To achieve accurate identification of
infectious complications, different cut-off values of POD3 CRP shall be
used in VO and non-VO patients.