Early prediction of anastomotic leakage after laparoscopic rectal surgery using creactive protein

Abstract

At present, anterior resection of the rectum or transabdominal rectal resection is the most common surgical technique for rectal cancer. Laparoscopic techniques are popular, and the efficacy and safety of laparoscopic rectal surgery have been confirmed. However, postoperative anastomotic leakage is a common, severe complication that leads to high mortality. Thus, early diagnosis of anastomotic leakage is important for reducing clinical consequences. The aim of this study was to determine whether C-reactive protein (CRP) is a good predictor of anastomotic leakage in laparoscopic transabdominal rectal resection. Our retrospective study involved a series of 196 rectal cancer patients who underwent laparoscopic transabdominal rectal resection without ileostomy between May 2013 and April 2015 at the Sir Run Run Shaw Hospital, Zhejiang University College of Medicine. The following patient data were collected: demographic data, manifestations of the complication, CRP levels and neutrophil percentage during the first 7 postoperative days. Anastomotic leakage was detected in 11 patients (5.6%). Each group showed significant differences ( P < .05) in CRP levels on postoperative days 3 to 7; compared with other groups, the anastomotic leakage group showed significant differences in CRP levels ( P < .05) on postoperative day 6. When patients were divided into groups with or without anastomotic leakage, CRP was a reliable predictor on postoperative days 4 to 7 ( P < .05, area under the curve > 0.800). The best combination was CRP on postoperative day 6 (area under the curve = 0.932) with a cut-off of 76.6 mg/L, resulting in a sensitivity of 83.3%, a specificity of 94.6% and a negative predictive value of 99%. CRP is a reliable predictor of anastomotic leakage after laparoscopic transabdominal rectal resection surgery. High CRP levels on postoperative days 4 to 7 indicate the need for a more careful patient evaluation.

Machine Learning-based Correlation Study between Perioperative Immunonutritional Index and Postoperative Anastomotic Leakage in Patients with Gastric Cancer

“…From the univariant analysis in this study, we found that CRP on POD 4 achieved optimal AUROC of 0.857 with a cutoff value of 159.5 (Figure 2). This result echoed afar with numerous researches recently [27][28][29][30][31] , suggesting that CRP was one of the most commonly used and widely verified clinical predictors for postoperative AL and other postoperative infections. Other variables presenting great potential include NLR on POD 4 (AUROC=0.802, cutoff value=10.55), minimum serum albumin during hospitalization (AUROC=0.7475, cutoff value=32.25) (Figure 2), which also indicated that poor overall immunonutritional internal environment may increase risk of postoperative AL.…”

The Usefulness of Inflammatory Biomarkers to Predict Anastomotic Leakage after Colorectal Surgery: Systematic Review and Meta-Analysis

“…1. Fifteen studies (12)(13)(14)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) met the defined inclusion criteria and had adequate data to be included in the meta-analysis.…”

Evaluation of the use of inflammatory biomarkers in the early detection of anastomotic leakage after esophagectomy: A retrospective analysis

“…The lack of a clear understanding of the pathophysiology behind AL led to the diversification of the investigated potential biomarkers across broad categories such as those of inflammation, ischemia, and tissue repair [ 11 ]. Although none of the examined biomarkers proved to be the gold standard, CRP shows promising results in contemporary literature [ 12 , 13 ].…”