Peri‐Operative Systemic Inflammatory Responses Predict Post‐Operative Complications in Patients Undergoing Pelvic Exenterative Surgery for Primary Locally Advanced Sigmoid and Rectal Cancer

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BACKGROUND AND OBJECTIVES: The systemic inflammatory response (SIR) is a recognized determinant of outcome in standard colorectal resections, yet its role in exenterative surgery remains unclear. The study aims to evaluate the relationship between peri-operative SIR biomarkers and post-operative complications in pelvic exenterative surgery. METHODS: A retrospective cohort study of consecutive patients undergoing pelvic exenteration (PE) or beyond total mesorectal excision (bTME) for primary locally advanced sigmoid and rectal cancers at a tertiary referral center. Clinicopathological variables, peri-operative complications, and SIR biomarkers (C-reactive protein [CRP], albumin, modified Glasgow Prognostic Score [mGPS] and neutrophil) were analyzed. Peri-operative SIR biomarkers and post-operative CRP were assessed as predictors of complications using Firth's penalized logistic regression. RESULTS: 114 patients were included; major and infective complications occurred in 29 (25.4%) and 49 (43.0%), respectively. Pre-operatively, high mGPS was associated with ASA ≥ 3, sigmoid tumor location and neutrophilia, whereas neutrophilia was associated with advanced tumor features (T stage and Extramural Venous Invasion), higher CRP, hypoalbuminemia, and ASA ≥ 3. Post-operative-day-3 (POD3) CRP > 150 mg/L independently predicted major (OR 7.40; 95% CI, 2.45-29.80; p < 0.001) and infective (OR 2.42; 95% CI, 1.09-5.58; p = 0.03) complications. CONCLUSIONS: POD3 CRP > 150 mg/L provides dynamic stratification of peri-operative morbidity and may facilitate early detection and targeted management of complications.

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