Skip to main content

Advertisement

SpringerLink
Log in

Is early CT in cases of elevated postoperative CRP the best option for the diagnosis of colorectal anastomotic leakage?

  • RESEARCH
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

After colorectal surgery (CRS), the early detection and treatment of anastomotic leakage (AL) is critical. We aimed to evaluate the efficacy of early contrast-enhanced computed tomography (CT) (postoperative day [POD] 2–3) after elective colorectal surgery for the diagnosis of AL for patients with elevated CRP levels at POD 2–3.

Method

From 2017 to 2022, all patients who underwent elective CRS with an anastomosis and CRP > 150 mg/ml on POD 2–3 underwent enhanced CT during the 24 h following the CRP evaluation and were included in this retrospective, single-center study. The primary endpoint was the diagnostic value of the early CT scan for the detection of AL. The secondary endpoints were the diagnostic value of the early CT scan for the detection of grade C AL according to the type of resection and anastomosis and the quality of the opacification.

Results

A total of 661 patients underwent elective CRS with anastomosis with an overall AL rate of 7.4%. Among the 661 patients, 141 were finally included in the study. The accuracy of early CT for the diagnosis of AL was 83.7%. For grade C AL, the accuracy was 81.6%. Among patients who had an ileocolic anastomosis, the accuracy was 88.2%, among those who had colorectal or ileorectal anastomosis, the accuracy was 83.0%, and among those who had a coloanal, the accuracy was 66.7%. In cases of good opacification by CT, the accuracy was 84.0%.

Conclusion

Early CT does not show perfect accuracy for an early diagnosis of AL.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Data availability

Data are available under reasonable demand.

References

  1. Midura EF, Hanseman D, Davis BR, Atkinson SJ, Abbott DE, Shah SA, Paquette IM (2015) Risk factors and consequences of anastomotic leak after colectomy: a national analysis. Dis Colon Rectum 58:333–338

    Article  PubMed  Google Scholar 

  2. Matthiessen P, Hallbook O, Rutegard J, Simert G, Sjodahl R (2007) Defunctioning stoma reduces symptomatic anastomotic leakage after low anterior resection of the rectum for cancer: a randomized multicenter trial. Ann Surg 246:207–214

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kiran RP, Murray AC, Chiuzan C, Estrada D, Forde K (2015) Combined preoperative mechanical bowel preparation with oral antibiotics significantly reduces surgical site infection, anastomotic leak, and ileus after colorectal surgery. Ann Surg 262:416–425; discussion 423–415

  4. Ishii M, Hamabe A, Okita K, Nishidate T, Okuya K, Usui A, Akizuki E, Satoyoshi T, Takemasa I (2020) Efficacy of indocyanine green fluorescence angiography in preventing anastomotic leakage after laparoscopic colorectal cancer surgery. Int J Colorectal Dis 35:269–275

    Article  PubMed  Google Scholar 

  5. Sciuto A, Merola G, De Palma GD, Sodo M, Pirozzi F, Bracale UM, Bracale U (2018) Predictive factors for anastomotic leakage after laparoscopic colorectal surgery. World J Gastroenterol 24:2247–2260

    Article  PubMed  PubMed Central  Google Scholar 

  6. Group EC (2015) The impact of enhanced recovery protocol compliance on elective colorectal cancer resection: results from an international registry. Ann Surg 261:1153–1159

    Article  Google Scholar 

  7. Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG (2014) Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg 101:339–346

    Article  CAS  PubMed  Google Scholar 

  8. Yeung DE, Peterknecht E, Hajibandeh S, Hajibandeh S, Torrance AW (2021) C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis 36:1147–1162

    Article  PubMed  Google Scholar 

  9. Ortega-Deballon P, Radais F, Facy O, d’Athis P, Masson D, Charles PE, Cheynel N, Favre JP, Rat P (2010) C-reactive protein is an early predictor of septic complications after elective colorectal surgery. World J Surg 34:808–814

    Article  PubMed  PubMed Central  Google Scholar 

  10. Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, McMillan DC (2012) C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer. Ann Surg Oncol 19:4168–4177

    Article  PubMed  Google Scholar 

  11. Stephensen BD, Reid F, Shaikh S, Carroll R, Smith SR, Pockney P, collaborators PSG (2020) C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study. Br J Surg 107:1832–1837

    Article  CAS  PubMed  Google Scholar 

  12. Hoek VT, Sparreboom CL, Wolthuis AM, Menon AG, Kleinrensink GJ, D’Hoore A, Komen N, Lange JF, collaborators AI (2022) C-reactive protein (CRP) trajectory as a predictor of anastomotic leakage after rectal cancer resection: A multicentre cohort study. Colorectal Dis 24:220–227

    Article  CAS  PubMed  Google Scholar 

  13. Alfonsi P, Slim K, Chauvin M, Mariani P, Faucheron JL, Fletcher D, Working Group of Societe francaise d’anesthesie et r, Societe francaise de chirurgie d (2014) French guidelines for enhanced recovery after elective colorectal surgery. J Visc Surg 151:65–79

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  15. Kulu Y, Ulrich A, Bruckner T, Contin P, Welsch T, Rahbari NN, Buchler MW, Weitz J, International Study Group of Rectal C (2013) Validation of the International Study Group of Rectal Cancer definition and severity grading of anastomotic leakage. Surgery 153:753–761

    Article  Google Scholar 

  16. Koedam TWA, Bootsma BT, Deijen CL, van de Brug T, Kazemier G, Cuesta MA, Furst A, Lacy AM, Haglind E, Tuynman JB, Daams F, Bonjer HJ, on behalf of the CCIIsg (2022) Oncological outcomes after anastomotic leakage after surgery for colon or rectal cancer: increased risk of local recurrence. Ann Surg 275:e420–e427

    Article  Google Scholar 

  17. Su’a B, Milne T, Jaung R, Jin JZ, Svirskis D, Bissett IP, Eglinton T, Hill AG (2022) Detection of anastomotic leakage following elective colonic surgery: results of the prospective biomarkers and anastomotic leakage (BALL) study. J Surg Res 273:85–92

    Article  CAS  PubMed  Google Scholar 

  18. Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P, Ortega-Deballon P (2012) C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg 149:e345–349

  19. McSorley ST, Khor BY, MacKay GJ, Horgan PG, McMillan DC (2017) Examination of a CRP first approach for the detection of postoperative complications in patients undergoing surgery for colorectal cancer: a pragmatic study. Medicine (Baltimore) 96:e6133

    Article  PubMed  Google Scholar 

  20. Straatman J, Cuesta MA, Gisbertz SS, Van der Peet DL (2014) Value of a step-up diagnosis plan: CRP and CT-scan to diagnose and manage postoperative complications after major abdominal surgery. Rev Esp Enferm Dig 106:515–521

    PubMed  Google Scholar 

  21. Holl S, Fournel I, Orry D, Facy O, Cheynel N, Rat P, Ortega-Deballon P (2017) Should CT scan be performed when CRP is elevated after colorectal surgery? Results from the inflammatory markers after colorectal surgery study. J Visc Surg 154:5–9

    Article  CAS  PubMed  Google Scholar 

  22. Huiberts AA, Dijksman LM, Boer SA, Krul EJ, Peringa J, Donkervoort SC (2015) Contrast medium at the site of the anastomosis is crucial in detecting anastomotic leakage with CT imaging after colorectal surgery. Int J Colorectal Dis 30:843–848

    Article  PubMed  Google Scholar 

  23. Marres CCM, van de Ven AWH, Leijssen LGJ, Verbeek PCM, Bemelman WA, Buskens CJ (2017) Colorectal anastomotic leak: delay in reintervention after false-negative computed tomography scan is a reason for concern. Tech Coloproctol 21:709–714

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Ikeda T, Kumashiro R, Taketani K, Ando K, Kimura Y, Saeki H, Oki E, Morita M, Akahoshi T, Hashizume M, Maehara Y (2015) Endoscopic evaluation of clinical colorectal anastomotic leakage. JSR 193:126–134

    Article  PubMed  Google Scholar 

Download references

Funding

No funding was obtained for this study.

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, CHU Amiens Picardie, 1 Rond point du Pr Cabrol, F-80054, Amiens Cedex 01, France

    Pauline Leourier, Alexandra Pellegrin, Jean-Marc Regimbeau & Charles Sabbagh

  2. Research unit UPJV 7518, SSPC (Simplification of Surgical Patients Care), University of Picardie Jules Verne, Amiens, France

    Pauline Leourier, Alexandra Pellegrin, Jean-Marc Regimbeau & Charles Sabbagh

Authors
  1. Pauline Leourier
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexandra Pellegrin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jean-Marc Regimbeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Charles Sabbagh
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Pauline Leourier and Charles Sabbagh. The first draft of the manuscript was written by Pauline Leourier, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Charles Sabbagh.

Ethics declarations

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Leourier, P., Pellegrin, A., Regimbeau, JM. et al. Is early CT in cases of elevated postoperative CRP the best option for the diagnosis of colorectal anastomotic leakage?. Int J Colorectal Dis 38, 278 (2023). https://doi.org/10.1007/s00384-023-04571-x

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00384-023-04571-x

Keywords

Search

Navigation