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Valor preditivo de marcadores inflamatórios no diagnóstico de deiscência anastomótica, em cirurgia de resseção gástrica
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| Documento em Acesso Embargado até dia 13-01-2026. Tente solicitar cópia ao autor carregando no ficheiro | 1.03 MB | Adobe PDF |
Abstract(s)
Introdução: O carcinoma gástrico é a quinta neoplasia mais prevalente a nível global, destacandose, também, por ser uma das formas de cancro mais letais. Na Europa, as taxas de sobrevivência são inferiores às do Oriente, onde este tipo de tumor é detetado mais precocemente. Uma das complicações mais temidas na cirurgia de ressecção que se realiza em doentes com tumores gástricos não metastizados é a DA (deiscência anastomótica). A DA é definida como não cicatrização de parte ou toda a circunferência da anastomose esofagojejunal, gastrojejunal e jejunojejunal (como uma anastomose da reconstrução em Y-de-Roux). Pode associar-se a abcessos, mediastinite e consequente sépsis com eventual necessidade de reintervenção. Esta complicação cirúrgica contribui substancialmente para o insucesso terapêutico, pelo que surge a necessidade de a detetar numa fase assintomática, de modo a poder realizar-se um tratamento atempado, e, assim, reduzir a morbimortalidade associada. Objetivos: Investigar o papel da PCR e do RNL na exclusão de DA, secundária à gastrectomia. Pretende-se, portanto, elucidar a importância de marcadores inflamatórios na gestão pós-operatória do cancro gástrico, avaliando se existe uma associação estatisticamente significativa entre os valores da PCR e do RNL que nos permita detetar precocemente a DA. Metodologia: Este estudo implicou a colheita de dados demográficos e clínicos relativos a uma população de 152 doentes (submetidos a gastrectomia radical com linfadenectomia D2 entre 1 de janeiro de 2018 e 31 de março de 2024, depois de aplicados os critérios de inclusão e exclusão. Para a recolha dos dados, acedeu-se à plataforma SClínico Hospitalar da ULS VDL. Os dados foram analisados com o programa estatístico IBM Statistical Package for the Social Sciences, versão 29.0.1. Para além dos dados para caracterização da amostra, colheram-se dados analíticos, incluindo os valores de os valores de PCR e o RNL diariamente, no pré-operatório e durante os cinco primeiros dias de internamento após a cirurgia a que foram submetidos. Contabilizou-se ainda se os doentes tiveram, ou não, complicações decorrentes da cirurgia e quais foram os doentes em quem se verificou DA. Resultados: Os resultados sugerem que é no quarto dia após a cirurgia que existe uma associação estatisticamente significativa entre os valores de RNL e PCR, que nos permitem detetar precocemente a DA. Ao quarto dia, a PCR apresenta um VPN de 100%, correspondendo-lhe um valor de corte de 12.935. Ao quinto dia a PCR apresenta o segundo VPN mais alto, com um valor de corte de 13.380. O RNL apresenta o maior VPN ao terceiro dia após a cirurgia (97.9%), ao qual corresponde um valor de corte de 5.883. Ao quarto dia de pós-operatório o RNL apresentou o segundo VPN mais elevado (97.5%), ao qual corresponde um ponto de corte de 7.600. Estes resultados sugerem que o aumento da PCR e RNL no quarto dia após a cirurgia têm valor preditivo de DA. Conclusões: A PCR e o RNL ao quarto dia podem ser usados, com segurança, para excluir DA. A monitorização contínua destes biomarcadores, após gastrectomia, pode facilitar a deteção precoce de complicações, permitindo intervenções rápidas e, com isso, melhorar o prognóstico dos doentes. A integração desses indicadores em protocolos de avaliação no pós-operatório de forma sistemática poderá reduzir a morbimortalidade associada à referida cirurgia, melhorando significativamente a progressão clínica do doente no pós-operatório.
Introduction: Gastric cancer is the fifth most prevalent neoplasm globally, also standing out as one of the most lethal forms of cancer. In Europe, survival rates are lower than in the Eastern countries, where this tumour was detected earlier. One of the most feared complications in surgery performed in patients with non-metastatic gastric tumours is AD. AD is defined as the non-healing of part or the entire circumference of the esophagojejunal anastomosis. It can be associated with abscesses, mediastinitis, and consequent sepsis with the possible need for reintervention. This surgical complication contributes substantially to therapeutic failure, meaning that there is necessary to detect it in an asymptomatic phase so that appropriate treatment can be properly carried out and avoid the resulting associated morbidity and mortality. Objectives: To investigate CRP and NLR's role in excluding AD secondary to gastrectomy. The aim of this study is to elucidate the importance of inflammatory markers in the postoperative management of gastric cancer, and whether there is a statistically significant association between CRP and NLR values that allows us to detect AD early. Methodology: After applying the inclusion and exclusion criteria, this study collected demographic and clinical data relating to the study population regarding participating patients. The ULS VDL SClinico Hospitalar platform was accessed to collect the data. The data were analysed using the IBM Statistical Package for the Social Sciences, version 29.0.1. In addition to the data for sample characterisation, analytical data were collected, including daily CRP and NLR values, pre-operatively and during the first five days after the surgery they underwent. It was also recorded whether or not the patients had complications resulting from the surgery and which patients had AD. Results: The results suggest that it is on the fourth postoperative day that there is a statistically significant association between NLR and CRP values, enabling the early detection of AD. On the fourth day, CRP demonstrated an NPV of 100%, with a cut-off value of 12.935. On the fifth day, CRP exhibited the second-highest NPV, with a cut-off value of 13.380. NLR showed the highest NPV on the third postoperative day (97.9%), corresponding to a cut-off value of 5.883. On the fourth postoperative day, NLR recorded the second-highest NPV (97.5%), with a cut-off value of 7.600. These findings suggest that increases in CRP and NLR on the fourth postoperative day have predictive value for AD. Conclusions: CRP and NLR on the fourth postoperative day are robust negative predictors of AD. Continuous monitoring of these biomarkers after gastrectomy can facilitate the early detection of complications, allowing rapid interventions and improving patients' prognosis. The integration of these indicators into postoperative assessment protocols can revolutionize healthcare, reducing morbidity and mortality from late detection of AD and significantly improving the patient's vital prognosis in the postoperative period.
Introduction: Gastric cancer is the fifth most prevalent neoplasm globally, also standing out as one of the most lethal forms of cancer. In Europe, survival rates are lower than in the Eastern countries, where this tumour was detected earlier. One of the most feared complications in surgery performed in patients with non-metastatic gastric tumours is AD. AD is defined as the non-healing of part or the entire circumference of the esophagojejunal anastomosis. It can be associated with abscesses, mediastinitis, and consequent sepsis with the possible need for reintervention. This surgical complication contributes substantially to therapeutic failure, meaning that there is necessary to detect it in an asymptomatic phase so that appropriate treatment can be properly carried out and avoid the resulting associated morbidity and mortality. Objectives: To investigate CRP and NLR's role in excluding AD secondary to gastrectomy. The aim of this study is to elucidate the importance of inflammatory markers in the postoperative management of gastric cancer, and whether there is a statistically significant association between CRP and NLR values that allows us to detect AD early. Methodology: After applying the inclusion and exclusion criteria, this study collected demographic and clinical data relating to the study population regarding participating patients. The ULS VDL SClinico Hospitalar platform was accessed to collect the data. The data were analysed using the IBM Statistical Package for the Social Sciences, version 29.0.1. In addition to the data for sample characterisation, analytical data were collected, including daily CRP and NLR values, pre-operatively and during the first five days after the surgery they underwent. It was also recorded whether or not the patients had complications resulting from the surgery and which patients had AD. Results: The results suggest that it is on the fourth postoperative day that there is a statistically significant association between NLR and CRP values, enabling the early detection of AD. On the fourth day, CRP demonstrated an NPV of 100%, with a cut-off value of 12.935. On the fifth day, CRP exhibited the second-highest NPV, with a cut-off value of 13.380. NLR showed the highest NPV on the third postoperative day (97.9%), corresponding to a cut-off value of 5.883. On the fourth postoperative day, NLR recorded the second-highest NPV (97.5%), with a cut-off value of 7.600. These findings suggest that increases in CRP and NLR on the fourth postoperative day have predictive value for AD. Conclusions: CRP and NLR on the fourth postoperative day are robust negative predictors of AD. Continuous monitoring of these biomarkers after gastrectomy can facilitate the early detection of complications, allowing rapid interventions and improving patients' prognosis. The integration of these indicators into postoperative assessment protocols can revolutionize healthcare, reducing morbidity and mortality from late detection of AD and significantly improving the patient's vital prognosis in the postoperative period.
Description
Keywords
Cirurgia Gástrica Gastrectomia Risco de Deiscência Anastomótica Marcadores Inflamatórios Proteína C Reativa Rácio Neutrófilos-Linfócitos Carcinoma Gástrico Deiscência Anastomótica Anastomotic Dehiscence Surgical Patients Gastric Carcinoma C-Reactive Protein Neutrophil/Lymphocyte Ratio Gastric Cancer Inflammatory Markers Anastomotic Leakage