Department of Surgery I, University Hospital Olomouc, Czech Republic.
Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.
Pol Przegl Chir. 2021 Jun 23;93(5):1-7. doi: 10.5604/01.3001.0014.6591.
Postoperative complications of rectal resections classified as grade III or higher according to Clavien-Dindo system, which also include anastomotic leaks, are usually life-threatening conditions. Delayed diagnosis may account for almost 18% of deaths. Due to nonspecific clinical signs in the early postoperative period, diagnosing these complications may truly be a challenge for clinicians. Nowadays, with the implementation of the ERAS protocol (enhanced recovery after surgery) and efforts concentrated on quickly delivered treatment to patients suffering from the above-mentioned complications, an appropriate marker with high specificity is required. Postoperative levels of C-reactive protein in blood serum seem promising in this aspect. The presented study aimed to determine the cut-off level of serum C-reactive protein as a possible predictive factor for early diagnosis of serious postoperative complications associated with rectal resections. This could also lead clinicians to the diagnosis of anastomotic leak after other possible options are ruled out. This study is a retrospective observational analysis of patients who underwent open resection of rectal cancer during a one-year period. Collected data included risk factors (age, gender, BMI, bowel preparation), record of complications and C Reactive Protein (CRP) serum levels. The study included 162 patients. Uncomplicated postoperative course was observed in 58 patients (35.8%). Complications were present in 104 cases (64.2%), including surgical site infections (16.7%) and anastomotic leak (9.9%). The mortality rate was 2.5%. Serum CRP threshold predicting relevant complications reached a sensitivity of 83.3% and specificity of 82.7% on POD 4, with a 175.4 mg/L cut-off value, burdened with a 95.7% negative predictive value. Postoperative serum C-reactive protein may be used as a good predictor of infectious complications, including anastomotic leaks. Measuring CRP levels in the early postoperative period may facilitate identification oflow-risk patients ensure early and safe discharges from hospital after rectal resections.
根据 Clavien-Dindo 系统分类为 III 级或更高级别的直肠切除术后并发症，包括吻合口漏，通常是危及生命的情况。延迟诊断可能占近 18%的死亡病例。由于术后早期临床症状不典型，这些并发症的诊断对临床医生来说确实是一个挑战。如今，随着 ERAS 方案（手术后加速康复）的实施以及集中精力快速为上述并发症患者提供治疗，需要一种具有高特异性的合适标志物。术后血清 C 反应蛋白水平在这方面似乎很有前景。本研究旨在确定血清 C 反应蛋白水平的截断值，作为早期诊断与直肠切除术相关的严重术后并发症的可能预测因子。这也可以帮助临床医生在排除其他可能的选择后诊断吻合口漏。本研究是对一年内接受开放式直肠癌切除术的患者进行的回顾性观察性分析。收集的数据包括危险因素（年龄、性别、BMI、肠道准备）、并发症记录和 C 反应蛋白（CRP）血清水平。该研究纳入了 162 名患者。58 名（35.8%）患者术后无并发症。104 例（64.2%）患者出现并发症，包括手术部位感染（16.7%）和吻合口漏（9.9%）。死亡率为 2.5%。预测相关并发症的血清 CRP 阈值在术后第 4 天达到了 83.3%的灵敏度和 82.7%的特异性，截断值为 175.4mg/L，阴性预测值为 95.7%。术后血清 C 反应蛋白可作为感染性并发症（包括吻合口漏）的良好预测因子。在术后早期测量 CRP 水平可能有助于识别低风险患者，确保直肠切除术后患者尽早安全出院。
