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

Abstract

IntroductionEarly 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.AimTo evaluate whether C-reactive protein (CRP) and procalcitonin (PCT) can predict AL before early discharge.Material and methodsFifty-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.ResultsTwenty-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.ConclusionsC-reactive protein and PCT measurement on POD 3 following colorectal cancer resection can positively identify patients at low risk of anastomotic leakage.

Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

“…Findings similar to ours, concerning the pro-inflammatory biomarker CRP have been reported by Zawadski et al (32) but with slightly higher discriminatory values for AL in their study by the 3rd postoperative day. An almost identical level of CRP and its postoperative timing and sensitivity for the diagnosis of AL was recently reported by Scepanovic et al (33).…”

“…Early elevation of measurable PCT (on the first or second postoperative days, for example), will be non-specific and reflect bacterial contamination or translocation secondary to bowel preparation. The PREDICS study (14) noted higher PCT levels on the 5th postoperative day than were found in our study on the 6th postoperative day, with Zawadski et al (32) also showing higher early PCT levels in their AL cases than noted in our study. Some authors have found that PCT adds no diagnostic value for an AL (14,35) whereas others have suggested that it is a better AL predictor when compared with CRP (36).…”

The value of biomarkers in early diagnosis of anastomotic leak following colorectal tumor resection: a review of the literature between 2012 and 2017

“…Another study by Marek showed that PCT measurement on POD 3 following colorectal cancer resection can positively identify patients at low risk of anastomotic leakage. The cut-off for PCT on POD 3 was 3.83 ng/ml, with sensitivity of 75% and specificity of 100% for AL [12]. A study performed in Spain also concluded that PCT is reliable predictor of major anastomotic leak after colorectal resection.…”

“…The cut-off value of 140 mg/L on POD3 maximized the sensitivity (78%) and specificity (86%) of serum CRP in assessing the risk of leakage [6]. Serum CRP has been evaluated in other 11 studies [7][8][9][10][11][12][13][14][15][16][17]. In general, the CRP level was raised significantly days before the diagnosis of AL.…”

“…Negative predictive value (96.7% and 96.7% respectively) Kostan, 2014, [11] CRP: POD4, cutoff value: 99 mg/L, Sensitivity 100%, specilficity 64% Marek, 2015, [12] CRP (POD3, cutoff value: 245.64 mg/l), PCT (POD3, cutoff value:3.83 ng/ml) CRP (sensitivity100%, specilficity 98%), PCT (sensitivity 75%, specilficity 100%) Waterland, 2016, [13] CRP (POD3 and POD4 with cut-off value of 209 and 123.5 mg/ml in laparotomy); CRP (POD2 with cut-off value of 146.5 mg/ml in laparoscopy)…”