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Role of C-reactive protein in early detection of anastomotic leak in patients undergoing elective colorectal resection surgery with primary anastomosis

Dobromir Dimitrov



Despite improvements in surgical technique and perioperative care anastomotic leaks (AL) are still present, causing increased morbidity, mortality, length of stay and costs.

The aim of this article is to study the role of c-reactive protein in early detection of anastomotic leak in the studied group.

Materials and Methods:

Prospective study in the period January 2017 - December 2018 of all patients undergoing elective colorectal surgery for cancer with primary colonic anastomosis in the Clinic of Surgical Oncology, Dr. G. Stranski University Hospital – Pleven was conducted. All patients were treated according to the ERAS protocols for colorectal surgery. The incidence of anastomotic leaks, changes in CRP and leukocyte (WBC) levels were studied.


A total of 201 patients were subjected to colonic resection in the Clinic for the study period. In 123 of the interventions an intestinal anastomosis was performed and this is the group of interest. Fifty-two of all interventions were minimally invasive. Anastomotic leak was found in 7 cases (5.7%), of which 2 patients were conservatively treated, and 5 patients were reoperated.

All patients with anastomotic insufficiency had serum levels of CRP above 130 mg/L. In five patients we found CRP levels above 130 mg/L without anastomotic leak. There were no patients with anastomotic insufficiency with CRP levels below 130 mg/L. The positive predictive value for these levels of CRP was 58.33% and the negative predictive value - 100%. In 85.7% of the patients with AL leukocyte (WBC) levels were in normal range at the time of AL detection.


CRP is an early marker with excellent negative predictive value for the development of anastomotic leak after colorectal surgery.


CRP, anastomotic leak, detection, rectal resection, primary anastomosis

Full Text


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About The Author

Dobromir Dimitrov
Medical University-Pleven

Department of Surgical Propaedeutics;

Department of Surgical Oncology, Dr. G. Stranski University Hospital, Pleven, Bulgaria

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