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C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy

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Abstract

Purpose

To investigate the factors predictive of anastomotic leakage in patients undergoing elective right-sided colectomy.

Methods

The subjects of this retrospective study were 247 patients who underwent elective right hemicolectomy or ileocecal resection with ileocolic anastomosis between April 2012 and March 2019, at our institution.

Results

Anastomotic leakage occurred in 9 of the 247 patients (3.6%) and was diagnosed on median postoperative day (POD) 7 (range POD 3–12). There were no significant differences in the background factors or preoperative laboratory data between the patients with anastomotic leakage (anastomotic leakage group) and those without anastomotic leakage (no anastomotic leakage group). Open surgery was significantly more common than laparoscopic surgery (P = 0.027), and end-to-side anastomosis was less common (P = 0.025) in the anastomotic leakage group. The C-reactive protein (CRP) level in the anastomotic leakage group was higher than that in the no anastomotic leakage group on PODs 3 (P < 0.001) and 5 (P < 0.001). ROC curve analysis revealed that anastomotic leakage was significantly more frequent in patients with a serum CRP level ≥ 11.8 mg/dL [area under the curve (AUC) 0.83].

Conclusion

A serum CRP level ≥ 11.8 mg/dL on POD 3 was predictive of anastomotic leakage being detected on median POD 7.

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References

  1. Foppa C, Ng SC, Montorsi M, Spinelli A. Anastomotic leak in colorectal cancer patients: new insights and perspectives. Eur J Surg Oncol. 2020;46(6):943–54.

    Article  Google Scholar 

  2. Ha GW, Kim JH, Lee MR. Oncologic impact of anastomotic leakage following colorectal cancer surgery: a systematic review and meta-analysis. Ann Surg Oncol. 2017;24(11):3289–99.

    Article  Google Scholar 

  3. Kobayashi H, Miyata H, Gotoh M, Baba H, Kimura W, Kitagawa Y, et al. Risk model for right hemicolectomy based on 19,070 Japanese patients in the national clinical database. J Gastroenterol. 2014;49(6):1047–55.

    Article  Google Scholar 

  4. Yoshida T, Miyata H, Konno H, Kumamaru H, Tangoku A, Furukita Y, et al. Risk assessment of morbidities after right hemicolectomy based on the national clinical database in Japan. Ann Gastroenterol Surg. 2018;2(3):220–30.

    Article  Google Scholar 

  5. Gustafsson P, Jestin P, Gunnarsson U, Lindforss U. Higher frequency of anastomotic leakage with stapled compared to hand-sewn ileocolic anastomosis in a large population-based study. World J Surg. 2015;39(7):1834–9.

    Article  Google Scholar 

  6. Nordholm-Carstensen A, Schnack Rasmussen M, Krarup PM. Increased leak rates following stapled versus handsewn ileocolic anastomosis in patients with right-sided colon cancer: a Nationwide Cohort Study. Dis Colon Rectum. 2019;62(5):542–8.

    Article  Google Scholar 

  7. Jurowich C, Lichthardt S, Matthes N, Kastner C, Haubitz I, Prock A, et al. Effects of anastomotic technique on early postoperative outcome in open right-sided hemicolectomy. BJS Open. 2019;3(2):203–9.

    Article  CAS  Google Scholar 

  8. Elod EE, Cozlea A, Neagoe RM, Sala D, Darie R, Sardi K, et al. Safety of anastomoses in right hemicolectomy for colon cancer. Chirurgia (Bucur). 2019;114(2):191–9.

    Article  Google Scholar 

  9. Kwak HD, Kim SH, Kang DW, Baek SJ, Kwak JM, Kim J. Risk factors and oncologic outcomes of anastomosis leakage after laparoscopic right colectomy. Surg Laparosc Endosc Percutan Tech. 2017;27(6):440–4.

    Article  Google Scholar 

  10. Jessen M, Nerstrom M, Wilbek TE, Roepstorff S, Rasmussen MS, Krarup PM. Risk factors for clinical anastomotic leakage after right hemicolectomy. Int J Colorectal Dis. 2016;31(9):1619–24.

    Article  Google Scholar 

  11. Frasson M, Granero-Castro P, Rodriguez JLR, Flor-Lorente B, Braithwaite M, Martinez EM, et al. Risk factors for anastomotic leak and postoperative morbidity and mortality after elective right colectomy for cancer: results from a prospective, multicentric study of 1102 patients. Int J Colorectal Dis. 2016;31(1):105–14.

    Article  Google Scholar 

  12. Sanchez-Guillen L, Frasson M, Garcia-Granero A, Pellino G, Flor-Lorente B, Alvarez-Sarrado E, et al. Risk factors for leak, complications and mortality after ileocolic anastomosis: comparison of two anastomotic techniques. Ann R Coll Surg Engl. 2019;101(8):571–8.

    Article  CAS  Google Scholar 

  13. Espin E, Vallribera F, Kreisler E, Biondo S. Clinical impact of leakage in patients with handsewn vs stapled anastomosis after right hemicolectomy: a retrospective study. Colorectal Dis. 2020;22(10):1286–92.

    Article  CAS  Google Scholar 

  14. Lee KH, Lee SM, Oh HK, Lee SY, Ihn MH, Kim DW, et al. Comparison of anastomotic configuration after laparoscopic right hemicolectomy under enhanced recovery program: side-to-side versus end-to-side anastomosis. Surg Endosc. 2016;30(5):1952–7.

    Article  Google Scholar 

  15. Peel AL, Taylor EW. Proposed definitions for the audit of postoperative infection: a discussion paper. Surgical Infection Study Group. Ann R Coll Surg Engl. 1991;73(6):385–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  16. de Ulibarri JI, Gonzalez-Madrono A, de Villar NG, Gonzalez P, Gonzalez B, Mancha A, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38–45.

    Google Scholar 

  17. Rausa E, Kelly ME, Asti E, Aiolfi A, Bonitta G, Bonavina L. Right hemicolectomy: a network meta-analysis comparing open, laparoscopic-assisted, total laparoscopic, and robotic approach. Surg Endosc. 2019;33(4):1020–32.

    Article  Google Scholar 

  18. Choy PY, Bissett IP, Docherty JG, Parry BR, Merrie A, Fitzgerald A. Stapled versus handsewn methods for ileocolic anastomoses. Cochrane Database Syst Rev. 2011;7(9): CD004320.

    Google Scholar 

  19. Stephensen BD, Reid F, Shaikh S, Carroll R, Smith SR, Pockney P. C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study. Br J Surg. 2020;107(13):1832–7.

    Article  CAS  Google Scholar 

  20. Singh PP, Zeng IS, 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. Br J Surg. 2014;101(4):339–46.

    Article  CAS  Google Scholar 

  21. Yeung DE, Peterknecht E, Hajibandeh S, Torrance AW. C-reactive protein can predict anastomotic leak in colorectal surgery: a systematic review and meta-analysis. Int J Colorectal Dis. 2021;36(6):1147–62.

    Article  Google Scholar 

  22. Watt DG, Horgan PG, McMillan DC. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review. Surgery. 2015;157(2):362–80.

    Article  Google Scholar 

  23. Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245(2):254–8.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan

    Toshiro Masuda, Hiroshi Takamori, Katsuhiro Ogawa, Kenji Shimizu, Ryuichi Karashima, Hidetoshi Nitta, Katsutaka Matsumoto & Tetsuya Okino

  2. Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-0811, Japan

    Katsuhiro Ogawa & Hideo Baba

Authors
  1. Toshiro Masuda
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  2. Hiroshi Takamori
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  3. Katsuhiro Ogawa
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  4. Kenji Shimizu
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  9. Hideo Baba
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Correspondence to Hiroshi Takamori.

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Masuda, T., Takamori, H., Ogawa, K. et al. C-reactive protein level on postoperative day 3 as a predictor of anastomotic leakage after elective right-sided colectomy. Surg Today 52, 337–343 (2022). https://doi.org/10.1007/s00595-021-02351-0

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  • DOI: https://doi.org/10.1007/s00595-021-02351-0

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