The Role of Serum Interleukin-6 Levels in Prognosticating Postoperative Complications After Cytoreductive Surgery for Ovarian Cancers: A Prospective Observational Study

Background: Interleukin-6 (IL-6), a pro-inflammatory cytokine, has been associated with adverse prognosis in ovarian cancer. Cytoreductive surgery for ovarian cancer has a higher risk of postoperative surgical complications (POCs). We aimed to find out if serum IL-6 is elevated preoperatively in patients undergoing cytoreductive surgery for ovarian cancer and if it can predict POCs. We also compared its trend with serum C-reactive protein (CRP) in the early postoperative period. Materials and Methods: Fifty-one patients between 18–75 years, posted for elective ovarian cytoreductive surgery at a tertiary cancer hospital were included after taking informed consent. Serum IL-6 and CRP were done the day before surgery and repeated 24 and 72 hours post-surgery. All parameters that affect POCs were captured. POCs were graded using the Clavein Dindo classification. We recorded the length of the intensive care unit (ICU), hospital stay, and 30-day mortality. Appropriate statistical tests were used and p value <0.05 was considered significant. Results: Out of 51 enrolled patients, 46 were included for data analysis after exclusions. The mean age of patients in this study was 49.76 +/- 12.42 years with a mean surgical duration of 302.39 +/- 127.04 minutes and mean blood loss of 332.6 +/- 274.71 mL. The incidence of POCs in our study was 21.7% (10/46 patients). Preoperative IL-6 was raised and was able to predict POCs with 70% sensitivity and 86% specificity at a cutoff value of 23.56 pg./mL (R2 = 0.71; AUC = 0.79). In patients who developed POCs, IL-6 values (1196.7+/-1461.4 pg./mL) peaked at 24 hours whereas CRP values (360 +/- 430.1 mg/L) peaked at 72 hours; thus, allowing early prognostication with IL-6. The cut-off value of serum IL-6 at 24 hours to predict POCs is 480 pg./mL (R2 = 0.50; AUC = 0.79) with 80% sensitivity and 89% specificity. Two patients died - on postoperative days 5 and 28 respectively. Conclusion: Preoperative IL-6 is raised in patients with ovarian cancer posted for cytoreductive surgery. A cut-off value of 23.56 pg./mL preoperatively and 480 pg./mL at 24 hours after surgery could predict postoperative surgical complications

The Reliability of Surgical Apgar Score in Predicting Immediate and Late Postoperative Morbidity and Mortality: A Narrative Review

Surgical Apgar Score is a simple, 10-point scoring system in which a low score reliably identifies those patients at risk for adverse perioperative outcomes. Surgical techniques and anesthesia management should be directed in such a way that the Surgical Apgar Score remains higher to avoid postoperative morbidity and mortality

The Reliability of Surgical Apgar Score in Predicting Immediate and Late Postoperative Morbidity and Mortality: A Narrative Review

Surgical Apgar Score is a simple, 10-point scoring system in which a low score reliably identifies those patients at risk for adverse perioperative outcomes. Surgical techniques and anesthesia management should be directed in such a way that the Surgical Apgar Score remains higher to avoid postoperative morbidity and mortality