IN THE NEWS
GENERAL SURGERY NEWS / SEPTEMBER 22021
C-Reactive Protein Levels: Ready for Prime Time In Assessing Anastomotic Leak? By ETHAN COVEY
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racking levels of C-reactive protein (CRP) in the body may help health care professionals to determine whether anastomotic leakage is occurring in patients who have recently undergone colorectal surgery. According to a pair of recent studies, monitoring CRP levels may signal leakage, thus acting as an easy, early indicator appearing before other radiological and clinical signs (Sci Rep 2020:10[1]. doi:10.1038/s41598-020-58780-3; Br J Surg 2020:107:1832-1837). “Anastomotic leakage is an undesirable complication of colorectal surgery, resulting in increased length of hospitalization, increased treatment costs, delayed return of intestinal homeostasis and decreased survival,” wrote the authors of a Brazilian study published in Scientific Reports. “Because vital signs and leukocyte numbers are slow in responding, it is important to identify tools to detect early leakage.” Despite advances in surgical techniques, the mortality rate among patients with anastomotic leakage is estimated to approach 30% (J Am Coll Surg 2009;208:269-278), and delayed diagnosis has been found to increase mortality by 18% (J Am Coll Surg 1999;189:554-559). The Brazilian study focused retrospectively on patients who underwent elective or emergency colorectal surgery with primary anastomosis at Carapicuíba General Hospital. The 90 patients were divided into two groups: 11 who experienced anastomotic leakage and 79 who did not. Serum CRP level was evaluated on each of the first seven postoperative days (PODs), as were other clinical parameters such as abdominal pain, volume, return of bowel function and/or appearance of abdominal drainage. Overall, surgical outcomes in patients who developed anastomotic leakage were far worse than in those who did not. Postoperative mortality was 18.2% in the group with leakage versus 1.3% in those without it; median hospital length of stay was 15 days for the leakage group compared with seven days in the nonleakage group; and 91.9% of patients in the group with leakage underwent surgical treatment. When looking specifically at CRP level, the researchers found no significant differences during the first three days after surgery. However, starting on POD 4, patients with leakage experienced significant increases in serum CRP level.
Peak CRP level occurred five days after surgery among patients with leakage. In contrast, in patients without leakage, CRP level peaked on POD 2 and fell from that point on. “Serum CRP levels can be routinely analyzed in patients who undergo elective or emergency colorectal surgery. Decreased CRP levels after POD 2 can exclude anastomotic
‘The liver is the sentinel of the body, tapping into bad things which may be happening in other parts of the body.’ —Peter K. Kim, MD
The Surgeon Orients in the OR for More Accurate Margin Analysis MarginMarker™ Sterile six-color ink kit; the surgeon applies ink to designate each margin for pathology.
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CorrectClips™ Sterile radiographic clips; the surgeon applies clips to orient specimen on the image.
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Request a Sample | VectorSurgical.com | +1 (262) 798-7970 Vector Surgical, the Vector Surgical Logo, MarginMarker and CorrectClips are trademarks of Vector Surgical LLC. Reg U.S. Pat & TM Off | © 2021 Vector Surgical LLC | References (1) Molina MA, Snell S, Franceshchi, D, et al. Breast specimen orientation. Ann Surg Oncol. 2009; 16:285-288. (2) Altman AM, Nguyen DD, Johnson B, et al. Intraoperative inking is superior to suture marking for specimen orientation in breast cancer. Breast J. 2019;00:1-7. (3) Singh M, Singh G, Hogan KT, Atkins KA, Schroen AT. The effect of intraoperative specimen inking on lumpectomy re-excision rates. World J Surg Oncol. 2010;8-4. (4) Van Den Bruele AB, Jasra B, Smotherman C, et al. Cost-effectiveness of surgeon performed intraoperative specimen ink in breast conservation surgery. Journal Surgical Research. 208;441-447 | MMCC SPREAD GSN SEP OCT 2021
