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Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program

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Abstract

Background

C-reactive protein (CRP) and procalcitonin (PCT) have been described as good predictors of anastomotic leak after colorectal surgery, obtaining the highest diagnostic accuracy on the 5th postoperative day. However, if an enhanced recovery after surgery (ERAS) program is performed, early predictors are needed in order to ensure a safe and early discharge. The aim of this study was to investigate the efficacy of CRP, PCT, and white blood cell (WBC) count determined on first postoperative days, in predicting septic complications, especially anastomotic leak, after laparoscopic colorectal surgery performed within an ERAS program.

Methods

We conducted a prospective study including 134 patients who underwent laparoscopic colorectal surgery within an ERAS program between 2015 and 2017. The primary endpoint investigated was anastomotic leak. CRP, PCT, and WBC count were determined in the blood sample extracted on postoperative day 1 (POD 1), POD 2 and POD 3.

Results

Anastomotic leak (AL) was detected in 6 patients (4.5%). Serum levels of CRP and PCT, but not WBC, determined on POD 1, POD 2, and POD 3 were significantly higher in patients who had AL in the postoperative course. Using ROC analysis, the best AUC of the CRP and PCT levels was on POD 3 (0.837 and 0.947, respectively). A CRP cutoff level at 163 mg/l yielded 85% sensitivity, 80% specificity, and 99% negative predictive value (NPV). A PCT cutoff level at 2.5 ng/ml achieved 85% sensitivity, 95% specificity, 44% positive predictive value, and 99% NPV.

Conclusions

CRP and PCT are relevant markers for detecting postoperative AL after laparoscopic colorectal surgery. Furthermore, they can ensure an early discharge with a low probability of AL when an ERAS program is performed.

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Authors and Affiliations

  1. Department of Anaesthesia, General University Hospital Elche, Camí de l´Almazara 11, CP 03203, Elche, Alicante, Spain

    José Luis Muñoz, Vicent Cuquerella, Elena Miranda, Carlos Picó, Raquel Flores, Marta Resalt-Pereira & Ana Pérez

  2. Department of Pathology, General University Hospital Elche, Alicante, Spain

    María Oliva Alvarez

  3. Department of Surgery, General University Hospital Elche, Alicante, Spain

    Pedro Moya & Antonio Arroyo

Authors
  1. José Luis Muñoz
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  2. María Oliva Alvarez
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  3. Vicent Cuquerella
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  4. Elena Miranda
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  5. Carlos Picó
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  7. Marta Resalt-Pereira
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  8. Pedro Moya
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  9. Ana Pérez
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  10. Antonio Arroyo
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Corresponding author

Correspondence to José Luis Muñoz.

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Disclosures

José Luis Muñoz, María Oliva Alvarez, Vicent Cuquerella, Elena Miranda, Carlos Picó, Raquel Flores, Marta Resalt-Pereira, Pedro Moya, Ana Pérez, and Antonio Arroyo have no conflicts of interest or financial ties to disclose.

Ethical approval

This study was approved by the local ethics committee.

Informal consent

All patients signed an informed consent form for the ERAS program and for inclusion in the study.

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Muñoz, J.L., Alvarez, M.O., Cuquerella, V. et al. Procalcitonin and C-reactive protein as early markers of anastomotic leak after laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) program. Surg Endosc 32, 4003–4010 (2018). https://doi.org/10.1007/s00464-018-6144-x

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  • DOI: https://doi.org/10.1007/s00464-018-6144-x

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