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. 2016 Jan;10(4):567-73.
doi: 10.5114/wiitm.2015.56999. Epub 2016 Jan 12.

C-reactive protein and procalcitonin predict anastomotic leaks following colorectal cancer resections - a prospective study

Marek Zawadzki  1 , Roman Czarnecki  1 , Marek Rzaca  1 , Zbigniew Obuszko  1 , Vamsi Ramana Velchuru  2 , Wojciech Witkiewicz  1
Affiliations

C-reactive protein and procalcitonin predict anastomotic leaks following colorectal cancer resections - a prospective study

Marek Zawadzki et al. Wideochir Inne Tech Maloinwazyjne. 2016 Jan.

Abstract

Introduction: Early safe discharge is paramount for the success of ERAS following colorectal cancer resections. Anastomotic leakage (AL) has high morbidity, particularly if the patient has been discharged to the community.

Aim: To evaluate whether C-reactive protein (CRP) and procalcitonin (PCT) can predict AL before early discharge.

Material and methods: Fifty-five consecutive patients undergoing open and robotic colorectal cancer resections were included. C-reactive protein and PCT were measured pre-operatively, 8 h after incision, and on the first and third postoperative day. Thirty-day readmissions, re-operations and mortality were recorded.

Results: Twenty-nine patients underwent robotic and the remainder open (n = 26) resections. Five patients had AL. The mean CRP and PCT increased on postoperative day 1 (POD 1) and POD 3 in all patients. On POD 3, mean CRP was 114 mg/l in non-AL patients and 321 mg/l in AL patients (p = 0.0001). Mean PCT on POD 3 was 0.56 ng/ml in the non-AL group and 10.4 ng/ml in AL patients (p = 0.017). On analysis of ROC and AUC curves, the cut-off for CRP on POD 3 was 245.64 mg/l, with 100% sensitivity and 98% specificity for AL. The cut-off for PCT on POD 3 was 3.83 ng/ml, with 75% sensitivity and 100% specificity for AL.

Conclusions: C-reactive protein and PCT measurement on POD 3 following colorectal cancer resection can positively identify patients at low risk of anastomotic leakage.

Keywords: C-reactive protein; anastomosis leak; colorectal; colorectal cancer; open surgery; robotic surgery.

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Figures

Figure 1
Figure 1
Evolution of median CRP over time
Figure 2
Figure 2
Evolution of median PCT over time
Figure 3
Figure 3
Receiver operating characteristic (ROC) curve for cut-off analysis of serum CRP in patients with AL
Figure 4
Figure 4
Receiver operating characteristic (ROC) curve for cut-off analysis of serum PCT in patients with AL
See this image and copyright information in PMC

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