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

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.