Predictive Value of Postoperative C-Reactive Protein in Anastomotic Leakage After Colon Cancer Surgery

Abstract

Background. Anastomotic leakage (AL) following colon surgery is a serious complication. Early diagnosis permits timely intervention and improvement in the clinical outcomes of the leak. C-reactive protein (CRP) has been shown to be a valuable marker of AL in several prospective studies. However, most of the recent studies include colon and rectum patients concurrently. The aim of this study was to evaluate the diagnostic accuracy of post-operative CRP measurement specifically in colon cancer surgery as its role in this setting is less well established. Methods. Patients who underwent elective colon resection for cancer with immediate anastomosis between January 2018 and December 2020 at Habib Bourguiba Hospital were included in this retrospective study. Results. Of the 59 patients involved in this study, the majority underwent sigmoidectomy (n=24) and right colectomy (n=23). Eight patients underwent left colectomy, three patients had segmental splenic flexure resection and one patient had a total colectomy. The median time for operation was 156 min [90 min-340 min]. Overall morbidity was 32,2%. Nine patients (15,3%) developed AL and the median time to diagnosis was POD 6 (range 4–10). On POD 3, a cut-off value of 170 mg/L was associated with the diagnosis of AL, with 85.71% sensitivity, 64.44% specificity and with a negative predictive value (NPV) of 96.67%. Using a cut-off value of 150 mg/L on POD 5, the sensitivity was 77.78%, the specificity was 85.19%, and the NPV was 92%. Conclusion. Patients with signs of sepsis and elevated CRP levels during the first 5 postoperative days should be closely monitored and considered for radiological exploration and possibly reoperation.