Scientific Online Resource System

Scripta Scientifica Medica

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

Dobromir Dimitrov

Abstract

Introduction:

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

Aim:
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.

Results:

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.

Conclusion:

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

Keywords

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

Full Text


References

Matthiessen P, Hallbook O, Andersson M, Rutegård J, Sjödahl R. Risk factors for anastomotic leakage after anterior resection of the rectum. Colo Dis. 2004;6(6):462–9. doi: 10.1111/j.1463-1318.2004.00657.x.

Leroy J, Jamali F, Forbes L, Smith M, Rubino F, Mutter D, et al. Laparoscopic total mesorectal excision (TME) for rectal cancer surgery: long term outcomes. Surg Endosc. 2004;18(2):281–9. doi: 10.1007/s00464-002-8877-8.

Leahy J, Schoetz D, Marcello P, Read T, Hall J, Roberts P, et al. What is the risk of clinical anastomotic leak in the diverted colorectal anastomosis? J Gastrointest Surg. 2014;18(10):1812–6. doi: 10.1007/s11605-014-2588-z.

Pronio A, Di Filippo A, Narilli P, Mancini B, Caporilli D, Piroli S, et al. Anastomotic dehiscence in colorectal surgery. Analysis of 1290 patients. Chir Ital. 2007;59(5):599–609.

Frasson M, Flor-Lorente B, Ramos Rodriguez JL, Granero-Castro P, Hervás D, Alvarez Rico MA, et al. Risk factors for anastomotic leak after colon resection for cancer: multivariate analysis and nomogram from a multicentric, prospective, national study with 3193 patients. Ann Surg. 2014;262(2):321–30. doi: 10.1097/SLA.0000000000000973.

Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11(1):8-15. doi: 10.1007/s11605-006-0049-z.

McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg. 2005;92(9):1150-4. doi: 10.1002/bjs.5054.

Walker KG, Bell SW, Rickard MJ, Mehanna D, Dent OF, Chapuis PH, et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg. 2004;240(2):255-9. doi: 10.1097/01.sla.0000133186.81222.08.

Karliczek A, Harlaar NJ, Zeebregts CJ, Wiggers T, Baas PC, van Dam GM. Surgeons lack predictive accuracy for anastomotic leakage in gastrointestinal surgery. Int J Colorectal Dis. 2009; 24(5):569–76. doi: 10.1007/s00384-009-0658-6.

Kingham TP, Pachter HL. Colonic anastomotic leak: risk factors, diagnosis, and treatment. J Am Coll Surg. 2009; 208(2):269–78. doi: 10.1016/j.jamcollsurg.2008.10.015.

Rullier E, Laurent C, Garrelon JL, Michel P, Saric J, Parneix M. Risk factors for anastomotic leakage after resection of rectal cancer. Br J Surg. 1998; 85(3):355–8. doi: 10.1046/j.1365-2168.1998.00615.x.

Vasiliu EC, Zarnescu NO, Costea R, Neagu S. Review of risk factors for anastomotic leakage in colorectal surgery. Chirurgia (Bucur). 2015;110(4):319-26.

Welsch T, Müller SA, Ulrich A, Kischlat A, Hinz U, Kienle P, et al. C-Reactive protein as early predictor for infectious postoperative complications in rectal surgery. Int J Color Dis. 2007;22(12):1499-507. doi: 10.1007/s00384-007-0354-3.

Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101(4):339-46. doi: 10.1002/bjs.9354.

Reynolds IS, Boland MR, Reilly F, Deasy A, Majeed MH, Deasy J, et al. C-reactive protein as a predictor of anastomotic leak in the first week after anterior resection for rectal cancer. Colorectal Dis. 2017;19(9):812-8. doi: 10.1111/codi.13649.

Ramos Fernández M, Rivas Ruiz F, Fernández López A, Loinaz Segurola C, Fernández Cebrián JM, de la Portilla de Juan F. C reactive protein as a predictor of anastomotic leakage in colorectal surgery. Comparison between open and laparoscopic surgery. Cir Esp. 2017;95(9):529-35. doi: 10.1016/j.ciresp.2017.08.003.

Sciuto A, Merola G, de Palma G, Sodo M, Pirozzi F, Bracale U, et al. Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol. 2018; 24(21): 2247–60. doi: 10.3748/wjg.v24.i21.2247.

Forsmo H, Erichsen C, Rasdal A, Körner H, Pfeffer F. Enhanced recovery after colorectal surgery (ERAS) in elderly patients is feasible and achieves similar results as in younger patients. Gerontol Geriatr Med. 2017; 3: 2333721417706299. doi: 10.1177/2333721417706299.

Paliogiannis P, Attene F, Scognamillo F, Trignano E, Torre C, Pulighe F, et al. Conservative management of minor anastomotic leakage after open elective colorectal surgery. Ann Ital Chir. 2012;83(1):25-8.

Gessler B, Eriksson O, Angenete E. Diagnosis, treatment, and consequences of anastomotic leakage in colorectal surgery. Int J Colorectal Dis. 2017;32(4):549-56. doi: 10.1007/s00384-016-2744-x.

Milito G, Lisi G, Venditti D, Campanelli M, Aronadio E, Grande S. Endoluminal vacuum therapy as treatment for anastomotic colorectal leakage. Surg Technol Int. 2017;30:125-30.




DOI: http://dx.doi.org/10.14748/ssm.v51i2.6063

Refbacks

About The Author

Dobromir Dimitrov
Medical University-Pleven
Bulgaria

Department of Surgical Propaedeutics;

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

Font Size


|