title: Using CRP to predict anastomotic leakage after open and laparoscopic colorectal surgery: is there a difference?
abstract: OBJECTIVE
  C-reactive protein (CRP) has proven to be a useful adjunct in early diagnosis of anastomotic leak (AL) after colorectal surgery. It would be of considerable value to examine whether modality of surgery has influence upon postoperative CRP serum levels and their predictive value in the diagnosis of AL.
  
  
  METHODS
  All patients undergoing elective colorectal surgery with anastomosis were enrolled into a prospective database between 2011 and 2014. AL was defined with strict operative and radiological criteria. Outcomes between open and laparoscopic resections were assessed statistically and Receiver Operating Characteristic (ROC) curve analysis performed.
  
  
  RESULTS
  Seven hundred twenty-seven patients with an intestinal anastomosis were identified including 468 laparoscopic procedures (468/727; 64 %). There were 58 anastomotic leaks (58/727; 7.9 %) of which 29 (6.2 %) were laparoscopic and 29 (11.2 %) were open. Mean CRP levels were significantly higher in patients after open surgery compared with laparoscopic both with AL (p = 0.013), and without (p = 0.02). ROC curve analysis revealed postoperative day 3 (cut-off CRP 209) and day 4 (cut-off CRP 123.5) to be most predictive of leak in the open group with an area under the curve (AUC) 0.794 (sensitivity 80 %, specificity 80 %) and AUC 0.806 (sensitivity 94 %, specificity 60 %), respectively. In the laparoscopic group, day 2 proved to be the most accurate day for detection of leak with a cut-off CRP of 146.5 showing 75 % sensitivity and a 70 % specificity (AUC 0.766).
  
  
  CONCLUSIONS
  CRP levels are higher after open surgery compared with laparoscopic surgery, both with and without AL. AL generates a significant detectable increase in CRP within 2-4 days after surgery.
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
authors.forename: P
authors.initials: P
authors.lastname: Waterland
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK. jimmypsng@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Ng
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
authors.forename: A
authors.initials: A
authors.lastname: Jones
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
authors.forename: G
authors.initials: G
authors.lastname: Broadley
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
authors.forename: D
authors.initials: D
authors.lastname: Nicol
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
authors.forename: H
authors.initials: H
authors.lastname: Patel
authors.affiliation: Worcestershire Acute Hospitals NHS Trust, Worcester, Worcestershire, UK.
authors.forename: S
authors.initials: S
authors.lastname: Pandey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology*; D002097:C-Reactive Protein / Q000378:metabolism*; D003107:Colorectal Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000473:pathology; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D055815:Young Adult
chemical_list: D002097:C-Reactive Protein
keywords: Anastomotic leak; C-reactive protein; Colorectal surgery