Introduction Predictive markers of anastomotic leak have been identified and include the use of post-operative C-reactive protein (CRP). A rising or post-operative day (POD) 3 CRP ≥ 140 is suggestive of anastomotic leak.
\We performed a retrospective review of post-operative CRP in anastomotic leak against the timing of clinical or radiologically detected anastomotic leak.
Method A prospectively collected database was used to identify all colorectal cancer resections over a 7-year period at a District General Hospital. This included both elective and emergency resections. From this data anastomotic leaks were identified. Post-operative CRP at day 1 and 3 and the time of clinical or imaging confirmed leak was retrospectively recorded for these patients. The data was then analysed.
Hospital stay and in-hospital mortality was also recorded.
Results A total of 1311 patients underwent colorectal cancer resections between January 2008 and December 2014. Of these we identified 45 anastomotic leaks (3.4%). These included 31 anterior resections, 8 right hemicolectomy, 4 left hemicolectomy and 2 other. Of the 31 anterior resections 48% (15/31) were de-functioned.
80% (35/44) of anastomotic leaks had a rising CRP and/or CRP ≥ 140 on POD 3. Of these 64% (29/44) had a POD 3 CRP ≥ 140 on its own. 84% (38/45) of patients underwent a diagnostic CT for clinically suspected anastomotic leak. The mean average days to clinical or radiologically detected anastomotic leak was 7 days.
The mean average length of stay was 33 days (range 10–88). There was a 4% (2/45) associated in-hospital mortality.
Conclusion Overall anastomotic leak rate is low. CRP has been shown to be sensitive and clinically relevant in our cohort. A proactive approach responding to CRP could lead to earlier detection of anastomotic leak. We recommend early CT imaging if CRP ≥140 on POD 3.
Disclosure of interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.