Postoperative inflammatory dynamics in sleeve gastrectomy: a systematic review and meta-analysis of CRP and TNF-α trends

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INTRODUCTION: Gastrectomy is a surgical procedure associated with significant inflammatory responses, characterized by alterations in biomarkers such as C-reactive protein (CRP) and tumor necrosis factor-alpha (TNF-α). Understanding these inflammatory dynamics is crucial for optimizing postoperative care and predicting long-term outcomes. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Scopus, Cochrane Library, and Web of Science were searched for studies published between 2014 and 2024 using predefined terms related to gastrectomy and inflammatory markers. Eligible studies assessed CRP and/or TNF-α levels post-gastrectomy. Effect sizes were calculated using Hedges' g , and heterogeneity was evaluated using Q -statistics, I2 , and τ2 . Forest plots visualized effect size trends across time points. RESULTS: From 2478 initial records, 46 studies met the inclusion criteria. A total of 5794 pre-surgery and 5696 post-surgery patients were included in CRP studies, while TNF-α studies involved 794 pre-surgery and 786 post-surgery patients. CRP levels rose sharply in the immediate postoperative period [1 postoperative day (POD): g = 1.12, P < 0.001; 2-7 POD: g = 1.44, P < 0.001], then progressively declined, showing significant reductions by 2-3 months ( g = -0.64, P < 0.001) and remaining low through 12 months ( g = -1.13, P < 0.001). TNF-α exhibited smaller, more variable decreases: -0.32 at 1-2 months ( P = 0.033), -0.66 at 3 months ( P < 0.001), -0.60 at 6 months ( P < 0.001), and -0.69 at 12 months ( P < 0.001). Heterogeneity was substantial ( I2 up to 98%). Funnel plots and Egger's tests indicated possible publication bias, especially for CRP. CONCLUSION: CRP and TNF-α reflect dynamic postoperative inflammation, with CRP showing a predictable early surge followed by sustained decline, and TNF-α showing modest but consistent reductions. These biomarkers may serve as valuable tools for monitoring recovery and guiding postoperative care.

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