C reactive protein as a predictor of anastomotic leakage in colorectal surgery. Comparison between open and laparoscopic surgery

• Published in: Cirugia Española Vol. 95; no. 9; p. 529
• Main Authors: Ramos Fernández, María, Rivas Ruiz, Francisco, Fernández López, Alberto, Loinaz Segurola, Carmelo, Fernández Cebrián, José María, de la Portilla de Juan, Fernando
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01-11-2017
• Subjects: Aged; Anastomotic Leak - blood; Anastomotic Leak - diagnosis; C-Reactive Protein - analysis; Colonic Diseases - surgery; Digestive System Surgical Procedures - methods; Female; Humans; Laparoscopy; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Rectal Diseases - surgery; Diagnostic test; Fuga anatomótica; Test diagnóstico; C reactive protein; Anastomotic leak; Cirugía colorrectal; Colorectal surgery; Proteína C reactiva
• ISSN: 1578-147X
• DOI: 10.1016/j.ciresp.2017.08.003

Anastomotic leak (AL) is a serious complication in colorectal surgery due to its increase in morbidity and mortality. The aim of this prospective non-randomised study is to determine whether C-reactive Protein (CRP) is useful as a predictor of AL in patients undergoing open versus laparoscopic surgery.
A total of 168 patients undergoing elective colorectal surgery were included. CRP was measured daily during the first 5postoperative days. Complications, specially AL, were analysed.
Following an open approach 32 patients (45.7%) presented complications, 15 (18.7%) in the laparoscopic group and 12 (29.4%) in the converted group (P=0.153). Following open surgery 9 patients experienced AL, 5 were detected in the laparoscopic group and none in those converted (P=0.153). There were significant differences in CRP values between the 3 groups (P=0.03). ROC Curves showed AUC for the open and laparoscopic approach of 0.731 and 0.760 respectively. On day 4 the AUC was 0.867 for the open group and 0.914 for the laparoscopic group. Cut-off points on day 4 were: Open: 159.2mg/L; sensitivity 75%, specificity 89% and NPP 96% (P<0.001). Following laparoscopic surgery the cut-off point was 67.3%; sensitivity 100%, specificity 89.5% and NPP 100% (P=0.016).
CRP on day 4 is useful to diagnose AL. Different cut-off values should be taken into account depending on the approach used.