Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection.
OBJECTIVE
This prospective study investigated the factors which might indicate anastomotic leakage after low anterior resection.


METHODS
Thirty-three patients who underwent anterior resection for rectal carcinoma (n = 32) and severe dysplasia (n = 1), were monitored daily by serum C-reactive protein (CRP) and white blood cell count (WBC) estimations until discharge from hospital. Computed tomography (CT) scans were performed on postoperative days 2 and 7 and the amount of presacral fluid collection was assessed. All patients had a pelvic drain and the volume of drainage was measured daily.


RESULTS
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.
Department of Surgery, Orebro University Hospital, Orebro, Sweden. peter.matthiessen@orebroll.se
P
P
Matthiessen
M
M
Henriksson
O
O
Hallböök
E
E
Grunditz
B
B
Norén
G
G
Arbman
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D014408:Biomarkers, Tumor / Q000097:blood; D001707:Biopsy, Needle; D002097:C-Reactive Protein / Q000032:analysis*; D016009:Chi-Square Distribution; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis; D011336:Probability; D011379:Prognosis; D011446:Prospective Studies; D012003:Rectal Fistula / Q000097:blood / Q000209:etiology*; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D016019:Survival Analysis
D014408:Biomarkers, Tumor; D002097:C-Reactive Protein