Identification of postoperative complications in sigmoid colon cancer and rectal cancer using the C-reactive protein level.

BACKGROUND

Postoperative 'surgery-associated' complications may require reoperation, so early detection and treatment are crucial. However, the decision to perform additional tests for a definitive diagnosis often relies on the surgeon's experience rather than objective criteria. The C-reactive protein (CRP) level is widely used as an indicator of acute-phase inflammation but also increases in response to surgical stress. Therefore, it is difficult to distinguish complications based solely on the CRP level. In this study, we examined the ability of the CRP level to predict complications after left-sided colorectal cancer surgery when patients are categorized according to day of onset of complications.

METHODS

This study includes a substantial proportion of patients undergoing robot-assisted surgery, differentiating it from previous studies. First, we performed linear regression analysis to create a predictive model for CRP levels during a normal postoperative course using the CRP level before surgery and on postoperative days (PODs) 1, 3, 5, and 7 from patients without complications. Next, we calculated the difference between the measured and predicted CRP values for all patients and investigated the correlation between these deviations and the occurrence of surgical complications on the day of CRP measurement or the following day.

RESULTS

Among 498 patients, forty-seven patients developed complications including 25 patients with surgical complications. When the CRP level measured on POD1 was ≥ 12.1 mg/dL and the deviation from the predicted value was ≥  + 6.7 mg/dL, the incidence of surgical complications was significantly higher. Similarly, on POD3, a measured CRP level of ≥ 10.8 mg/dL and a deviation of ≥  + 4.14 mg/dL were significantly associated with an increased incidence of surgical complications.

CONCLUSION

The deviation between CRP levels measured on POD1 and POD3 from those in patients with a normal postoperative course after surgery for left-sided colorectal cancer is useful for identifying imminent surgical complications.