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C-reactive protein and its ratio are useful indicators to exclude anastomotic leakage requiring intervention after laparoscopic rectal surgery

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Abstract

The goal of this study was to determine whether C-reactive protein (CRP) levels and its ratios can be used as indicators to exclude postoperative anastomotic leak (AL) requiring intervention in patients undergoing elective laparoscopic total mesorectal excision (TME) without a diverting ileostomy for middle or low rectal cancer. We measured CRP values on postoperative days (POD) 1, 2, and 4 and CRP ratios between two PODs in 1278 consecutive patients undergoing rectal surgery. The incidence of AL requiring intervention was 5.9%, and 92% of AL occurred by POD 4. The CRP levels on POD 4 had a maximal area under the curve (AUC) of 0.956 with a negative predictive value (NPV) of 99.7% when the cutoff was established as 80 mg/l. Also, the ratio between CRP levels on POD 4 and CRP levels on POD 2 (CRP POD 4/2) was the most accurate indicator among the CRP ratios, with an AUC of 0.959 and an NPV of 99.5% when the cutoff was set at one. CRP on POD 4 < 80 mg/l and the ratio of CRP POD 4/2 < 1 can be used to rule out AL requiring intervention in patients undergoing elective laparoscopic TME without a diverting ileostomy for middle or low rectal cancer.

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Funding

This work was supported by Department of Finance of Jilin Province (JLSWSRCZX2020-0016) and Department of Science and Technology of Jilin Province (20200802010GH).

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, The First Hospital of Jilin University, Jilin University, Changchun, 130031, People’s Republic of China

    Jiaxin Zhang, Dong Yang, Yinquan Zhao, Mingjie Xia, Meng Li & Quan Wang

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  1. Jiaxin Zhang
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  2. Dong Yang
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  3. Yinquan Zhao
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  4. Mingjie Xia
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  5. Meng Li
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Contributions

JZ and QW conceived the study. DY, YZ and ML performed data collection and analysis. JZ wrote the manuscript; QW and JZ critically revised the article.

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Correspondence to Quan Wang.

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Research involving human participants and/or animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the First Hospital of Jilin University (No. 20k085-001).

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Zhang, J., Yang, D., Zhao, Y. et al. C-reactive protein and its ratio are useful indicators to exclude anastomotic leakage requiring intervention after laparoscopic rectal surgery. Updates Surg 74, 1637–1643 (2022). https://doi.org/10.1007/s13304-022-01358-7

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  • DOI: https://doi.org/10.1007/s13304-022-01358-7

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