C-Reactive Protein Changes in Oral Cancer Patients After Resection and Reconstructive Surgery

구강암 수술 및 재건 환자에서의 C-Reactive Protein 수치의 변화

  • Kim, Chul-Hwan (Departments of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University) ;
  • Hwang, Seung-Yeon (Departments of Oral and Maxillofacial Surgery, College of Dentistry, Dankook University)
  • 김철환 (단국대학교 치과대학 구강악안면외과학교실) ;
  • 황승연 (단국대학교 치과대학 구강악안면외과학교실)
  • Received : 2010.05.13
  • Accepted : 2010.07.09
  • Published : 2010.09.30

Abstract

Purpose: The aim of this study is that we evaluate the change of the White Blood Cell(WBC) count, Absolute Neutrophil Count (ANC), Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) values, and try to make standardization for postoperative sequels before and after the oral cancer resection and reconstructive surgery. Materials and Methods: The study was comprised of 34 patients (male 15, female 19) who were diagnosed as an oral cancer and had performed ablation and reconstructive surgery at Dankook university dental hos-pital. Each blood specimen was collected from patients and estimated WBC count, Neutrophil count, ESR, CRP on first, third, fifth, seventh day efore and after surgery and analyzing inter relationship between each value. Classifying Group I (resection with reconstructive surgery patients) and Group II (resection without reconstructive surgery patients). Also classifying group A (below 4 hours of operation time), Group B (4 to 8 hours of operation time), Group C (above 8 hours of operation time), each group was analyzed and compared. The Following results were induced. Results: (1) In coefficient of correlation, the CRP and WBC has highest value except WBC count and Neutrophil count. (2) There was no significant difference any lapse in the progress between Group I and II of WBC count, Neutrophil count, but the CRP shows statistically higher level in group I than group II at immediate postoperative day, and 1 to 5 days after surgery. (3) There is no significant difference any lapse in the progress between Group A, B, C of WBC count, Neutrophil count, but CRP shows statistically significant difference in 1 day, 3 days after surgery Conclusion: It should be suggested that, determination of CRP is most valuable parameter for postopera-tive management and determination of postoperative clinical changes than other parameter such as WBC count, neutrophil count, and ESR values in oral cancer patient after resection and reconstructive surgery, based on the results of this study.

Keywords

References

  1. Young EW, Johnson WT, Lundin R : Evaluation of treatment provided patients hospitalized with orofacial odontogenic infection : A retrospective study. Oral Surg Oral Med Oral Pathol 59 : 28, 1985. https://doi.org/10.1016/0030-4220(85)90111-2
  2. Haug RH, Hoffman MJ, Indresano AT : An epidemiologic and anatomic survey of odontogenic infections. J Oral Maxillofac Surg 49 : 976, 1991. https://doi.org/10.1016/0278-2391(91)90063-R
  3. Krishnan V, Johnson JV, Helfrick JF : Management of maxillofacial infections: A review of 50 cases. J Oral Maxillofac Surg 51 : 868, 1991.
  4. Osmand AP, Friedenson B, Gewurz H et al : Characterization of C-reactive protein and the complement subcomponent Clq as homologous protein displaying cyclic pentameric symmetry. Proc Nat Acad Sci 74 : 739, 1977. https://doi.org/10.1073/pnas.74.2.739
  5. Pepys MB : C-reactive protein fifty years on. Lancet 3 : 653, 1981.
  6. Young B, Gleeson M, Cripps AW : C-reactive protein : A critical review. Pathology 23 : 118, 1991. https://doi.org/10.3109/00313029109060809
  7. Lee SY : C-reactive protein : Clinical Laboratory medicine, 5th edi. p.628.
  8. Culver DH, Horan TC, Gaynes RP et al : Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance Sytem. Am J Med 91 : 152, 1991. https://doi.org/10.1016/0002-9343(91)90361-Z
  9. Lim TJ : The study of C-reactive protein following surgery. The Keimyung Univ Med J 10 : 503, 1991.
  10. Jameson P, Desborough JP, Bryant AE et al : The effect of cortisol suppression on interleukin-6 and white blood cell responses to surgery. Acta Anaesthesiol Scand 41 : 304, 1997. https://doi.org/10.1111/j.1399-6576.1997.tb04683.x
  11. Toft P, Svendsen P, Tonnensen E et al : Redistribution of lymphocytes after major surgical stress. Acta Anaesthesiol Scand 37 : 245, 1993. https://doi.org/10.1111/j.1399-6576.1993.tb03708.x
  12. Tonnesen E, Brinklov MM, Christensen NJ et al : Natural killer cell activity and lymphocyte function during and after coronary artery bypass grafting in relation to the endocrine stress response. Anesthesiology 67 : 526, 1987. https://doi.org/10.1097/00000542-198710000-00014
  13. O'Sullivan ST, Leaderer JA, Horgan AF et al : Major injury leads to predominance of the T Helper-2 lymphocyte phenotype and diminished interleukin-12 production associated with decreased resistance to infection. Annal Sur 222 : 482, 1995. https://doi.org/10.1097/00000658-199522240-00006
  14. Hansbrough JF, Zapata-Sirvent RL, Bartle EJ et al : Alterations in splenic lymphocyte subpopulations and increased mortality from sepsis follwing anesthesia in mice. Anesthesiology 63 : 267, 1985. https://doi.org/10.1097/00000542-198509000-00005
  15. Decker D, Schondorf M, Bidlingmaier F et al : Surgical stress induces a shift in the type-1/type-2 T helper cell balance, suggesting down regulation of cell-mediated immunity commensurate to the trauma. Surgery 119 : 316, 1996. https://doi.org/10.1016/S0039-6060(96)80118-8
  16. Kim BJ, Lim Y, Lee JH et al : The Clinical Significance of CRP for the Postoperative Infection in Orthopedic Surgery. Journal of the Korean orthopaedic association 27 : 1074, 1992.
  17. Zlonis M : The mystique of the erythrocyte sedimentation rate. Clin Lab Med 13 : 787, 1993.
  18. Bottiger LE, Svedberg CA : Normal erythrocyte sedimentation rate and age. Br. Med. J. 2 : 85, 1967.
  19. Lee HK, Ahn BW, Song HS : Clinical Observations on Acute Pyogenic Osteomyelitis and Arthritis in Infancy. Journal of the Korean orthopaedic association 12 : 735, 1980.
  20. Park BM, Choi YK : A Clinical Study of Septic Arthritis in Children. Journal of the Korean orthopaedic association 12 : 746, 1980.
  21. Fischer CL, Gill C, Forrester MG et al : Quantitation on acute phase proteins postoperatively. Value in detection and monitoring of complications. Am J Clin Pathol 66 : 840, 1976. https://doi.org/10.1093/ajcp/66.5.840
  22. Tillett WS, Francis T : Serological reactoins in pneumonia with a non-protein somaic fraction of pneumococcus. J Exp Med 52 : 561, 1980.
  23. Abermethy TJ, Avery OT : The occurrence during acute infections of a protein not normally presentin the blood. I. Distribution of the reactive protein in patients' sera and the effect of calcium on the flocculation reaction with C polysaccharide of pneumococcus. J Exp Med 73 : 173, 1941. https://doi.org/10.1084/jem.73.2.173
  24. MacLeod CM, Avery OT : The occurrence during acute infections of a protein not normally present in the blood. II. Isolation and properties of the reactive protein. J Exp Med 73 : 183, 1941. https://doi.org/10.1084/jem.73.2.183
  25. Reny JL, Vuagnat A, Ract C : Diagnosis and follow-up of infections in intensive care patients : Value of C-reactive protein compared with other clinical and biological variables. Crit Care Med 30 : 529, 2002. https://doi.org/10.1097/00003246-200203000-00006
  26. Clyne B, Olshaker JS : The C-reactive protein. J Emerg Med 17 : 1019, 1999. https://doi.org/10.1016/S0736-4679(99)00135-3
  27. Terregino CA, Lopez BL, Karras DJ : Endogenous Mediators in emergency depaortment patients with presumed sepsis : Are levels associated with progression to severe sepsis and teath? Ann Emerg Med 35 : 26, 2000. https://doi.org/10.1016/S0196-0644(00)70101-6
  28. Evans MI, Hajj SN, Devoe LD : C-reactive protein as a predictor of infectious morbidity with premature rupture of membranes. Am J Obstet Gynecol 13 : 648, 1980.
  29. Dawes PT, Fowler PT, Clarke S : Rheumatoid arthritis : treatment which controls the C-reactive protein and erythrocyte sedimentation rate reduces radiological progression. Br J Rheumatol 25 : 44, 1986. https://doi.org/10.1093/rheumatology/25.1.44
  30. Kim ID, Lee SY, Kim PT : A diagnostic value of C-reactive protein in acute bacterial infection of bone and joint. J of Korean Orthop Assoc 21 : 39, 1986.
  31. Mustard RA Jr, Bohnen JMA, Haseeb S : C-reactive protein levels predict postoperative septic complications. Arch Surg 122 : 69, 1987. https://doi.org/10.1001/archsurg.1987.01400130075011
  32. Fassbender K, Pargger H, Muller W : Interleukin-6 and acute-phase protein concentrations in surgical intensive care unit patients : Diagnostic signs in nosocomial infection. Crit care Med 21 : 1175, 1993. https://doi.org/10.1097/00003246-199308000-00017
  33. Saarinen UM, Strandjord SE, Warkentin PI : Differentiation of presumed sepsis from acute graft-versus-host-disease by C-reactive protein and serum total IgE in bone marrow transplant recipients. Transplantation 44 : 540, 1987. https://doi.org/10.1097/00007890-198710000-00017
  34. Mayer AD, McMahon MJ, Bowen M et al : C-reactive protein. An aid to assessment and monitoring of acute pancreatitis, J Clin Pathol 37 : 207, 1984. https://doi.org/10.1136/jcp.37.2.207
  35. Peltola H, Vahvanen V, Aalto K : Fever, C-reactive protein and erythrocyte sedimentation rate in monitoring recovery from septic arthritis. A Preliminary Study. Journal of Pediatric Orthopedics 4 : 170, 1984. https://doi.org/10.1097/01241398-198403000-00004
  36. Peltola HO : C-reactive protein for rapid monitoring of infection of the central nerve system. The Lancet 1 : 980, 1982.
  37. Hasselgren PO : Changes of protein metabolism in liver ad skeletal muscle following complicated by sepsis. J Trauma 24 : 224, 1984. https://doi.org/10.1097/00005373-198403000-00007
  38. Pepys MV, Druguet M, Klass HJ et al : Immunological sudies in inflammatory bowel diseas, N: Knight, J, Poerter R, (eds): Immunology of the Gut. Ciba Fdn Symp 46. Amsterdam, Excerpta Medica, 1977, p.283.
  39. Kallio P, Michelsson JE, Lalla M et al : C-reactive protein in tibial fractures. J Bone Joint Surg 72-B : 615, 1990. https://doi.org/10.1302/0301-620X.72B4.2380213
  40. Larsson S, Thelander U, Friberf S : C-reactive protein(CRP) levels after elective orthopedic surgery. Clin Orthop 275 : 237, 1992.
  41. Iizuka T, Lindqvist C : Changes in C-reactive protein associated with surgical treatment of mandibular fractures. J Oral Maxillofac Surg 49 : 464, 1991. https://doi.org/10.1016/0278-2391(91)90168-L
  42. Colley CM, Fleck A, Goode AW et al : Early time course of the acute phase protein response in man. J Clin Path 36 : 203, 1983. https://doi.org/10.1136/jcp.36.2.203
  43. Crockson RA, Payne CJ, Ratcliff AP et al : Tine sequence of acute phase reactive proteins following surgical trauma. Clin Chem Acta 14 : 435, 1966. https://doi.org/10.1016/0009-8981(66)90030-1
  44. Gewurz H, Mold C, Siegel J : C-reactive protein and the acute phase response. Adv Int Med 27 : 345, 1982.
  45. Dawson JB : A simple, standard, erythrocyte sedimentation rate. Lab med. 35 : 37, 1972.