An investigation into the relationship between the perioperative systemic inflammatory response and postoperative complications in patients undergoing surgery for colorectal cancer

Colorectal cancer is the second most common cause of cancer death in the western world. Despite improvements in diagnosis and treatment, 50% of patients still die from this disease. It is now recognised that postoperative infective complications contribute to poor cancer specific survival following resection for colorectal cancer. The basis of this observation is not clear. One hypothesis is that the presence of a raised systemic inflammatory response may be responsible. Whether a raised postoperative inflammatory response is the result of an early underlying infection at a preclinical stage, or whether a raised inflammatory response leads to increased susceptibility to subsequent infection is not known. If the former proves true, it is possible that targeting at risk patients with pre emptive antibiotics may reduce infective complications and improve patient outcomes. Conversely, if the latter is the case, perioperative intervention to reduce the postoperative inflammatory response may reduce infective complications and hence improve outcomes, both short and long term, for patients undergoing colorectal cancer resection. The work presented in this thesis further examines the relationship between the systemic inflammatory response and postoperative infective complications following resection for colorectal cancer, determines predictive thresholds for the development of postoperative infective complications, assesses the impact of the peak systemic inflammatory response on these thresholds and investigates the determinants of the peak response. Finally, the question as to whether a raised postoperative systemic inflammatory response is the cause or consequence of infective complications is examined