Increase of serum C‐reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

Abstract

The level of the anastomosis was at a median 5 cm (3-12 cm) above the anal verge. There was no 30-day mortality. Nine (27.2%) of the 33 patients developed a symptomatic anastomotic leakage which was diagnosed at a median of 8 days (range 4-14) postoperatively. The serum CRP was increased in patients who leaked from postoperative day 2 onwards (P = 0.004 on day 2; P < 0.001 on day 3-8). The WBC was decreased in preoperatively irradiated patients on days 1-5 (P </= 0.021), with no difference seen between patients with or without leakage. Patients with leakage had a larger presacral fluid collection on CT on day 7 (median 76 ml vs 52 ml; P = 0.016) and a larger increase in the fluid collection between the first and the second CT examinations (28 ml vs 3 ml; P = 0.046). CONCLUSION; An early rise in serum CRP was a strong indicator of leakage. Monitoring of CRP for possible early detection of symptomatic anastomotic leakage is recommended.

Diagnostic Accuracy of C-reactive Protein for Intraabdominal Infections After Colorectal Resections

“…22,28 Both studies reported persistently increased CRP values after POD 2-4 in patients later diagnosed with an anastomotic leak. Matthiessen et al 28 prospectively studied several risk factors for anastomotic leaks in 33 patients, and Welsch et al 22 compared 48 patients with anastomotic leaks to 48 matched patients with an uncomplicated postoperative course from a large database. However, in both studies, the median CRP values were used as cut-offs with their corresponding diagnostic accuracy.…”

Diagnostic Value of Serial Measurement of C-Reactive Protein in the Detection of a Surgical Complication after Laparoscopic Bowel Resection for Endometriosis

“…We have shown that a decrease in inflam- We are aware that the anastomotic leakage rate is relatively high compared with other series [23,31,32] . However, our results represent consecutive patients including our first experience.…”

Fecal Volume after Laparoscopic Low Anterior Resection Predicts Anastomotic Leakage

“…Instead, several studies have only described the preoperative and intraoperative risk factors for AL. High CRP levels on POD 3 or persistently elevated CRP levels are considered to be early predictors of AL after colorectal surgery [10][11][12][13][14] . However, one paper reported no differences in CRP levels between the AL and non-AL groups after total colectomy for familial adenomatous polyposis [16] .…”

“…A sustained high fever and contaminated discharge from the intra-abdominal drain are the clinical signs of AL after LAR. In addition, an increased serum C-reactive protein (CRP) level might be an early indicator of AL after LAR [10][11][12][13][14] . The early predictors of AL are very useful in clinical practice.…”