Postoperatif 7. Gün C-Reaktif Protein/Albümin Oranı ile Cerrahi Komplikasyonların Öngörülmesi: Kolon Kanseri Hastalarında Erken Risk Belirleme Aracı
Yıl 2026,
Cilt: 16 Sayı: 1, 18 - 22, 31.01.2026
Suat Evirgen
,
Meryem Çetin
Öz
Amaç:
Bu çalışma, elektif kolorektal kanser cerrahisi sonrası gelişebilecek cerrahi komplikasyonların öngörülmesinde, postoperatif 7. gün ölçülen C-reaktif protein/albumin oranının (CAR) prediktif değerini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntem:
Ocak 2017 ile Aralık 2023 tarihleri arasında küratif amaçlı kolorektal rezeksiyon uygulanan 200 hasta retrospektif olarak incelendi. Demografik ve perioperatif veriler ile 30 günlük postoperatif komplikasyonlar değerlendirildi. CRP ve albumin düzeyleri, ameliyat öncesi ve postoperatif 7. günde ölçüldü. CAR, CRP (mg/dL) değerinin albumin (g/dL) değerine bölünmesiyle hesaplandı. Komplikasyonlar Clavien–Dindo sınıflamasına göre değerlendirildi.
Bulgular:
Hastaların %40’ında postoperatif komplikasyon gelişti. Komplikasyon gelişen grupta postoperatif 7. gün CRP düzeyleri daha yüksek, albumin düzeyleri ise daha düşük bulundu; buna bağlı olarak CAR değeri anlamlı düzeyde yüksekti (ortalama CAR: 5.07 ± 2.05 vs. 2.31 ± 1.12; p<0.001). CAR değeri ≥3.2 olan hastalarda komplikasyon oranı belirgin olarak yüksekti. Ayrıca, komplikasyon gelişen hastalarda hastanede kalış süresi daha uzundu (medyan: 12 gün vs. 7 gün; p<0.001).
Sonuç:
Postoperatif 7. gün ölçülen CAR değeri, kolorektal kanser cerrahisi sonrası gelişebilecek komplikasyonları öngörmede basit, düşük maliyetli ve etkili bir biyobelirteç olabilir. CAR takibi, erken dönemde yüksek riskli hastaların belirlenmesine yardımcı olarak klinik yönetim kararlarının şekillendirilmesine katkı sağlayabilir.
Etik Beyan
ETİK ONAY AMASYA ÜNİVERSİTESİ ETİK KURULUNDAN ,23.05.2025 TARİHİNDE, Sayı : E-76988455-050.01-263366 NUMARASI İLE ALINMIŞTIR.
Destekleyen Kurum
AMASYA ÜNİVERSİTESİ
Teşekkür
AMASYA ÜNİVERSİTESİ ŞEREFEDDİN SABUNCUOĞLU EĞİTİM ARAŞTIRMA HASTANESİ GENEL CERRAHİ VE MİKROBİOLOJİ ÇALINŞANLARINA TEŞEKKÜR EDERİM.
Kaynakça
-
1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.
-
2. Marginean SS, Zurzu M, Garofil D, et al. Evaluation of key risk factors associated with postoperative complications in colorectal cancer surgery. J Mind Med Sci. 2025;12(1):22.
-
3. Rennie O, Sharma M, Helwa N. Colorectal anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks. Front Surg. 2024;11:1371567.
-
4. Denicu MM, Cârțu D, Râmboiu S, et al. Anastomotic leakage after colorectal surgery: risk factors, diagnosis and therapeutic options. Curr Health Sci J. 2023;49(3):333-42.
-
5. Tevis SE, Kennedy GD. Postoperative complications: looking forward to a safer future. Clin Colon Rectal Surg. 2016;29(3):246-52.
-
6. Bao QR, Pellino G, Spolverato G, et al. The impact of anastomotic leak on long-term oncological outcomes after low anterior resection for mid-low rectal cancer: extended follow-up of a randomised controlled trial. Int J Colorectal Dis. 2022;37(7):1689-98.
-
7. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368-75.
-
8. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157(2):362-80.
-
9. Bain CR, Myles PS, Martin C, et al. Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes. Anaesthesia. 2023;78(11):1365-75.
-
10. Warschkow R, Steffen T, Beutner U, Müller SA, Schmied BM, Tarantino I. Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients. Int J Colorectal Dis. 2012;27(10):1377-82.
-
11. Platt JJ, Ramanathan ML, Crosbie RA, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19(13):4168-77.
-
12. Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339-46.
-
13. van Boekel AM, van der Meijden SL, Geerts BF, et al. C-reactive protein in the first 30 postoperative days and its discriminative value as a marker for postoperative infections, a multicentre cohort study. BMJ Open.
2025;15(4):e093615.
-
14. Gielen AHC, Schoenmakers M, Breukink SO, et al. The value of C-reactive protein, leucocytes and vital signs in detecting major complications after oncological colorectal surgery. Langenbecks Arch Surg. 2024;409(1):76.
-
15. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr. 2019;43(2):181-93.
-
16. Capurso C, Lo Buglio A, Bellanti F, Serviddio G. C-reactive protein to albumin ratio predicts early mortality in hospitalized older patients, independent of the admission diagnosis. Nutrients. 2025;17(12):1984.
-
17. Shibutani M, Maeda K, Nagahara H, Iseki Y, Ikeya T, Hirakawa K. Prognostic significance of the preoperative ratio of C-reactive protein to albumin in patients with colorectal cancer. Anticancer Res. 2016;36(3):995-1001.
-
18. Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Shibuya N, Kubota K. Clinical significance of the C-reactive protein to albumin ratio for survival after surgery for colorectal cancer. Ann Surg Oncol. 2016;23(3):900-7.
-
19. Swarnkar M, Pendkar R. Diagnostic accuracy of the postoperative C - reactive protein to albumin ratio in prediction of complications after major abdominal surgery. J Family Med Prim Care. 2020;9(12):5944-47.
-
20. Sert ÖZ, Bozkurt H, Ölmez T, et al. C-reactive protein to albumin ratio: a reliable marker in colorectal cancer. Turk J Colorectal Dis. 2021;31(1):35-42.
-
21. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96.
-
22. Watt DG, McSorley ST, Park JH, Horgan PG, McMillan DC. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol. 2017;24(4):1100-09.
-
23. Hanahan D. Hallmarks of cancer: new dimensions. Cancer Discov. 2022;12(1):31-46.
-
24. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261(3):497-505.
C-Reactive Protein to Albumin Ratio: Is it a Predictor of Surgical Complications in Colorectal Cancer Surgery?
Yıl 2026,
Cilt: 16 Sayı: 1, 18 - 22, 31.01.2026
Suat Evirgen
,
Meryem Çetin
Öz
Aim:
This study aimed to evaluate the predictive value of the C-reactive protein to albumin ratio (CAR), measured on postoperative day 7, for identifying surgical complications following elective colorectal cancer surgery.
Materials and Methods:
A retrospective analysis was conducted on 200 patients who underwent curative colorectal resections between January 2017 and December 2023. Demographic and perioperative data, as well as 30-day postoperative complications, were reviewed. CRP and albumin levels were assessed preoperatively and on postoperative day 7. CAR was calculated as CRP (mg/dL) divided by albumin (g/dL). Complications were classified according to the Clavien–Dindo system.
Results:
Postoperative complications occurred in 40% of patients. On day 7, those with complications had significantly higher CRP levels, lower albumin levels, and elevated CAR values (mean CAR: 5.07 ± 2.05 vs. 2.31 ± 1.12; p<0.001). A CAR value of ≥3.2 was associated with a notably higher rate of complications. Additionally, patients with complications had a significantly longer hospital stay (median: 12 vs. 7 days; p<0.001).
Conclusion:
The postoperative day-7 CAR is a simple and cost-effective biomarker that may assist in identifying patients at higher risk of surgical complications after colorectal cancer surgery. Monitoring CAR in the early postoperative period may support risk stratification and guide clinical decision-making.
Etik Beyan
Ethical approval was obtained from the Amasya University Ethics Committee on May 23, 2025, with the reference number E-76988455-050.01-263366
Destekleyen Kurum
Amasya University
Teşekkür
The authors would like to thank the staff of the Department of General Surgery and the Department of Microbiology at Amasya University Şerefeddin Sabuncuoğlu Training and Research Hospital for their valuable contributions
Kaynakça
-
1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49.
-
2. Marginean SS, Zurzu M, Garofil D, et al. Evaluation of key risk factors associated with postoperative complications in colorectal cancer surgery. J Mind Med Sci. 2025;12(1):22.
-
3. Rennie O, Sharma M, Helwa N. Colorectal anastomotic leakage: a narrative review of definitions, grading systems, and consequences of leaks. Front Surg. 2024;11:1371567.
-
4. Denicu MM, Cârțu D, Râmboiu S, et al. Anastomotic leakage after colorectal surgery: risk factors, diagnosis and therapeutic options. Curr Health Sci J. 2023;49(3):333-42.
-
5. Tevis SE, Kennedy GD. Postoperative complications: looking forward to a safer future. Clin Colon Rectal Surg. 2016;29(3):246-52.
-
6. Bao QR, Pellino G, Spolverato G, et al. The impact of anastomotic leak on long-term oncological outcomes after low anterior resection for mid-low rectal cancer: extended follow-up of a randomised controlled trial. Int J Colorectal Dis. 2022;37(7):1689-98.
-
7. Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med. 2009;361(14):1368-75.
-
8. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157(2):362-80.
-
9. Bain CR, Myles PS, Martin C, et al. Postoperative systemic inflammation after major abdominal surgery: patient-centred outcomes. Anaesthesia. 2023;78(11):1365-75.
-
10. Warschkow R, Steffen T, Beutner U, Müller SA, Schmied BM, Tarantino I. Diagnostic accuracy of C-reactive protein and white blood cell counts in the early detection of inflammatory complications after open resection of colorectal cancer: a retrospective study of 1,187 patients. Int J Colorectal Dis. 2012;27(10):1377-82.
-
11. Platt JJ, Ramanathan ML, Crosbie RA, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol. 2012;19(13):4168-77.
-
12. Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339-46.
-
13. van Boekel AM, van der Meijden SL, Geerts BF, et al. C-reactive protein in the first 30 postoperative days and its discriminative value as a marker for postoperative infections, a multicentre cohort study. BMJ Open.
2025;15(4):e093615.
-
14. Gielen AHC, Schoenmakers M, Breukink SO, et al. The value of C-reactive protein, leucocytes and vital signs in detecting major complications after oncological colorectal surgery. Langenbecks Arch Surg. 2024;409(1):76.
-
15. Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr. 2019;43(2):181-93.
-
16. Capurso C, Lo Buglio A, Bellanti F, Serviddio G. C-reactive protein to albumin ratio predicts early mortality in hospitalized older patients, independent of the admission diagnosis. Nutrients. 2025;17(12):1984.
-
17. Shibutani M, Maeda K, Nagahara H, Iseki Y, Ikeya T, Hirakawa K. Prognostic significance of the preoperative ratio of C-reactive protein to albumin in patients with colorectal cancer. Anticancer Res. 2016;36(3):995-1001.
-
18. Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Shibuya N, Kubota K. Clinical significance of the C-reactive protein to albumin ratio for survival after surgery for colorectal cancer. Ann Surg Oncol. 2016;23(3):900-7.
-
19. Swarnkar M, Pendkar R. Diagnostic accuracy of the postoperative C - reactive protein to albumin ratio in prediction of complications after major abdominal surgery. J Family Med Prim Care. 2020;9(12):5944-47.
-
20. Sert ÖZ, Bozkurt H, Ölmez T, et al. C-reactive protein to albumin ratio: a reliable marker in colorectal cancer. Turk J Colorectal Dis. 2021;31(1):35-42.
-
21. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187-96.
-
22. Watt DG, McSorley ST, Park JH, Horgan PG, McMillan DC. A postoperative systemic inflammation score predicts short- and long-term outcomes in patients undergoing surgery for colorectal cancer. Ann Surg Oncol. 2017;24(4):1100-09.
-
23. Hanahan D. Hallmarks of cancer: new dimensions. Cancer Discov. 2022;12(1):31-46.
-
24. Artinyan A, Orcutt ST, Anaya DA, Richardson P, Chen GJ, Berger DH. Infectious postoperative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer: a study of 12,075 patients. Ann Surg. 2015;261(3):497-505.