C Reactive Protein and early detection of postoperative complications in laparoscopic colorectal surgery
Keywords:
colon, postoperative complications, anastomotic leakage, laparoscopy, C-reactive proteinAbstract
Introduction: Early diagnosis of postoperative complications in colorectal surgery poses a challenge for the surgeon. C-reactive protein is a circulating plasma protein that is part of the acute phase reactants, whose levels in the blood increase during the inflammatory response.
Objective: To evaluate the usefulness of C-reactive protein as a predictor of postoperative complications in laparoscopic colorectal surgery.
Method: Prospective case series study conducted during the period between January 2021 and December 2022. A total of 97 patients who underwent laparoscopic surgery due to colorectal disease were included. Serum levels of C-reactive protein were recorded on the third day post-surgery. The studied variables included sex, age, ASA classification, nutritional status, comorbidities, surgical intervention, surgical time, and complications. The Mann-Whitney U test was used to detect significant differences between the reactant levels on the third day and the frequency of complications. The Kruskal-Wallis test was employed to detect significant differences between the reactant levels and the observed complications.
Results: In complicated patients, the median reached a value of 186.4 mg/L, exceeding the values of the non-complicated patients (104.3 mg/L). The most identified complications were anastomosis leakage and surgical site infection.
Conclusions: This protein has a high negative predictive value for complications (close to 90%). It proved to be a useful element for the timely prediction of complications following laparoscopic colorectal surgery.
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1. Wagner G, Valsangiacomo P, Rodríguez Cantera G, Segura D, Ruso Martínez L. Procalcitonina y proteína C reactiva como marcadores precoces de falla de sutura digestiva [Internet]. Cir Urug. 2018; 2(3):2-11. DOI: 10.31837/cir.urug/2.2.1
2. Ramos Fernández M, Rivas Ruiz F, Fernández López A, Loinaz Segurola C, Fernández Cebrián JM, de la Portilla de Juan F. Proteína C reactiva como predictor de fuga anastomótica en cirugía colorrectal. Comparación entre cirugía abierta y laparoscópica [Internet]. Cir Esp. 2017; 95(9):529-35. DOI: http://dx.doi.org/10.1016/j.ciresp.2017.08.003
3. Hoang SC, Klipfel AA, Roth LA, Vrees M, Schechter S, Shah N. Colon and rectal surgery surgical site infection reduction bundle: to improve is to change [Internet]. The American Journal of Surgery. 2019; 217(1):40-5. DOI: https://doi.org/10.1016/j.amjsurg.2018.07.008
4. Gray M, Marland RK J, Murray AF, Argyle DJ, Potter MA. Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients [Internet]. J Pers Med. 2021; 11:2-29. DOI: https://doi.org/10.3390/jpm11060471
5. Magill L, Perry R, Sheward N, Hervas D, Cillo M, Estefania D, et al. Predictors for anastomotic leak, postoperative complications, and mortality after right colectomy for cancer: results from an international snapshot audit [Internet]. Diseases of the Colon & Rectum. 2020; 63(5):606-18. Disponible en: https://doi.org/10.1097/DCR.0000000000001590
6. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey [Internet]. Ann Surg. 2004; 240(2):205-13. DOI: https://doi:10.1097/01.sla.0000133083.54934.ae
7. de la Portilla F, Builes S, García-Novoa A, Espín E, Kreisler E, Enríquez-Navascues JM, et al. Análisis de los indicadores de calidad en la cirugía de cáncer colorrectal de unidades acreditadas por la Asociación Española de Coloproctología [Internet]. Cirugía Española. 2018; 96(4):226-33. DOI: https://doi.org/10.1016/j.ciresp.2018.02.008
8. Arredondo Ortiz MA, Hernández Amador JF, Villanueva Sáenz E. Preparación del colon en la cirugía colorrectal electiva [Internet]. Acta médica Grupo Ángeles. 2019 [acceso: 8/08/2021]; 17(1):33-7. Disponible en: https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=85459
9. Campos Campos SF, Ureña Álvarez JA, Fuentes Orozco C, Barbosa Camacho J, Barrera López FJ, Jiménez Ley VB, et al. Dehiscencia de anastomosis gastrointestinal. Qué hacer y qué no hacer [Internet]. Cirujano General. 2019 [acceso: 26/01/2021]; 41(4):243-55. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1405-00992019000400243
10. Declaración de Helsinki de la AMM-Principios éticos para las investigaciones médicas con participantes humanos [Internet].2024 [acceso: 7/11/2025] Disponible en: https://www.wma.net/es/policies-post/declaracion-de-helsinki-de-la-amm-principios-eticos-para-las-investigaciones-medicas-en-seres-humanos/
11. Buccafusca G, Proserpio I, Tralongo AC, Rametta Giuliano S, Tralongo P. Early colorectal cancer: diagnosis, treatment and survivorship care [Internet]. Critical Reviews in Oncology/Hematology. 2020 [acceso: 11/12/2021]; 136(2):20-30. DOI: https://doi.org/10.1016/j.critrevonc.2019.01.023
12. Bae HJ, Kim ST, Hong SG, Lee H, Choi HS, Cho Y, et al. Risk Factors for Asymptomatic Colon Diverticulosis [Internet]. The Korean Journal of Gastroenterology. 2019; 74(3):142-53. DOI: https://doi.org/10.4166/kjg.2019.74.3.142
13. Albiza Sotomayor L, Betancour Cervantes JR, Camejo Rodríguez D, Meneses García A, Odales Cruz DA. Factores predictores de mortalidad en la oclusión intestinal por cáncer colorrectal y anal [Internet]. Revista Cubana de Cirugía. 2020 [acceso: 27/06/2021]; 59(1):915. Disponible en: http://scielo.sld.cu/scielo.php?pid=S0034-74932020000100007&script=sci_arttext&tlng=en
14. Fernández Santiesteban LT, Hernández Álvarez FE, González Villalonga JA, Lima Pérez M, González Meisozo M. Resultados del tratamiento quirúrgico en pacientes con cáncer colorrectal avanzado [Internet]. Revista Cubana de Cirugía. 2020 [acceso: 02/10/2021]; 59(2): E_935. Disponible en: https://www.medigraphic.com/pdfs/cubcir/rcc-2020/rcc202d.pdf
15. Montes-de-Oca-Mastrapa JL, de la Caridad Cera-Gisbert A. Caracterización de pacientes operados de cáncer colorrectal en Puerto Padre, estudio de cuatro años [Internet]. Revista Electrónica Dr. Zoilo E. Marinello Vidaurreta. 2021 [acceso: 05/02/2022]; 46(5):2874. Disponible en: https://revzoilomarinello.sld.cu/index.php/zmv/article/view/2874/pdf
16. Centers for Disease Control and Prevention. Surgical Site Infection (SSI) Event [Internet]. CDC; 2020. [acceso: 17/11/2021]. Disponible en: https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscSSIcurrent.pdf
17. Hayati F, Mohd Azman ZA, Nasuruddin DN, Mazlan L, Zakaria AD, Sagap I. Serum Procalcitonin Predicts Anastomotic Leaks in Colorectal Surgery [Internet]. Asian Pac J Cancer Prev. 2017 [acceso: 01/05/2021]; 18(7):1821-5. Disponible en: https://europepmc.org/article/pmc/5648385
18. Smith SR, Pockney P, Holmes R, Doig F, Attia J, Holliday E, et al. Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard [Internet]. ANZ J Surg. 2018 [acceso: 06/09/2022]; 88(5):440-4. Disponible en: https://europepmc.org/article/med/28304142
19. Woeste G, Müller C, Bechstein WO, Wullstein C. Increased serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery [Internet]. World J Surg. 2010 [acceso: 31/10/2022]; 34(1):140-6. Disponible en: https://europepmc.org/article/med/19953248
20. Platt JJ, Ramanathan ML, Crosbie RA, Anderson JH, McKee RF, Horgan PG, et al. C-reactive protein as a predictor of postoperative infective complications after curative resection in patients with colorectal cancer [Internet]. Ann Surg Oncol. 2012 [acceso: 24/07/2021]; 19(13):4168-77. Disponible en: https://europepmc.org/article/med/22805866
21. Mik M, Dziki L, Berut M, Trzcinski R, Dziki A. Neutrophil to Lymphocyte Ratio and C-Reactive Protein as Two Predictive Tools of Anastomotic Leak in Colorectal Cancer Open Surgery [Internet]. Dig Surg. 2018 [acceso: 30/01/2021]; 35(1):77-84. Disponible en: https://europepmc.org/article/med/28132052
22. Tatsuoka T, Okuyama T, Takeshita E, Oi H, Noro T, Mitsui T, et al. Early detection of infectious complications using C-reactive protein and the procalcitonin levels after laparoscopic colorectal resection: a prospective cohort study [Internet]. Surg Today. 2021 [acceso: 15/07/2022]; 51(3):397-403. Disponible en: https://europepmc.org/article/med/32785845
23. Messias BA, Botelho R v., Saad SS, Mocchetti ER, Turke KC, Waisberg J. Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery [Internet]. Sci Rep. 2020 [acceso: 20/11/2022]; 10(1):1687. Disponible en: https://europepmc.org/article/med/32015374
24. Ho YM, Laycock J, Kirubakaran A, Hussain L, Clark J. Systematic use of the serum C-reactive protein concentration and computed tomography for the detection of intestinal anastomotic leaks [Internet]. ANZ J Surg. 2020 [acceso: 07/07/2022]; 90(1–2):109112. Disponible en: https://europepmc.org/article/med/31770827
25. The Italian Colorectal Anastomotic Leakage Study Group. Anastomotic leakage after elective colorectal surgery: a prospective multicentre observational study on use of the Dutch leakage score, serum procalcitonin and serum C-reactive protein for diagnosis [Internet]. BJS open. 2020 [acceso: 08/03/2022]; 4(3):499507. Disponible en: https://europepmc.org/article/med/32134216
26. Carvello M, di Candido F, Greco M, Foppa C, Maroli A, Fiorino G, et al. The trend of C-Reactive protein allows a safe early discharge after surgery for Crohn’s disease [Internet]. Updates Surg. 2020 [acceso: 18/01/2021]; 72(4):985-989. Disponible en: https://europepmc.org/article/med/32406043
27. Cazelles A, Giacca M, Monsinjon M, Hain E, Frontali A, Panis Y. Monitoring of C-reactive protein decreases length of stay after laparoscopic total mesorectal excision for cancer: a prospective case-matched study in 236 patients [Internet]. Colorectal dis. 2021 [acceso: 24/04/2022]; 23(5):1158-66. Disponible en: https://europepmc.org/article/med/33554408
28. Singh PP, Zeng ISL, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery [Internet]. Br J Surg. 2014 [acceso: 27/06/2022]; 101(4):339-46. Disponible en: https://europepmc.org/article/med/24311257
29. Cousin F, Ortega-Deballon P, Bourredjem A, Doussot A, Giaccaglia V, Fournel I. Diagnostic Accuracy of Procalcitonin and C-reactive Protein for the Early Diagnosis of Intra-abdominal Infection After Elective Colorectal Surgery [Internet]. Ann Surg. 2016 [acceso: 21/10/2021]; 264(2):252-6. Disponible en: https://europepmc.org/article/med/27049766
30. Lyadov VK, Garipov MR, Polushkin VG, Tarasov NA, Ayupov RT, Feoktistov D. C-Reactive protein as early predictor of anastomotic leakage after surgery for colorectal cancer. Systematic review and meta-analysis [Internet]. Khirurgiia. 2020 [acceso: 05/07/2021]; (8):82-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/32869620/
31. Paradis T, Zorigtbaatar A, Trepanier M, Fiore JF, Fried GM, Feldman LS, et al. Meta-analysis of the Diagnostic Accuracy of C-Reactive Protein for Infectious Complications in Laparoscopic Versus Open Colorectal Surgery [Internet]. J Gastrointest Surg. 2020 [acceso: 25/12/2021]; 1392-1401. Disponible en: https://europepmc.org/article/med/32314233
32. Yeung DE, Peterknecht E, Hajibandeh S, Hajibandeh S, Torrance AW. C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis [Internet]. Int J Colorectal Dis. 2021 [acceso: 02/09/2022]; 36:1147-62. Disponible en: https://europepmc.org/article/med/33555423
33. Sheng S, Zhao T, Wang X. Comparison of robot-assisted surgery, laparoscopic-assisted surgery, and open surgery for the treatment of colorectal cancer: A network meta-analysis [Internet]. Medicine (Baltimore). 2018; 97(34):e11817. DOI: 10.1097/MD.0000000000011817
34. Yang SX, Sun ZQ, Zhou QB, Xu JZ, Chang Y, Xia KK, et al. Security and Radical Assessment in Open, Laparoscopic, Robotic Colorectal Cancer Surgery: A Comparative Study [Internet]. Technol Cancer Res Treat. 2018; 17:1533033818794160. DOI: 10.1177/1533033818794160
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Copyright (c) 2025 Miguel Licea Videaux, Luis Fernando Moraila García, Orlando Zamora Santana, Susel Quesada Peña, Miguel Ángel Martínez Alfonso, Iván Ulises Palacios Morejón, Jose Luis González González, Orlando de Jesús Vega Olivera
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