Increased Levels of C-reactive Protein and Leukocyte Count Are Poor Predictors of Anastomotic Leakage Following Laparoscopic Colorectal Resection

Introduction: Laparoscopic procedure and fast-track regimen with short post-operative hospital stay are gaining ground in colorectal surgery. The aim of the present study was to determine whether the levels of C-reactive protein (CRP) and white blood cell counts (WBC) have a role as early predictors of post-operative septic complications including anastomotic leakage in patients operated laparoscopically in a fast-track regimen.

Material And Methods: This was a retrospective analysis of 129 patients who underwent laparoscopic colorectal surgery in a fast-track regimen during a one-year period. The levels of CRP and WBC were measured daily until discharge. The diagnostic accuracy was evaluated using the receiver-operating characteristics methodology.

Results: The median post-operative hospital stay was three days. Septic complications occurred in 32% of cases. Post-operative CRP level was significantly higher in patients with septic complications than in patients without complications, but similar in patients with anastomotic leakage and patients with other septic complications. The best cut-off value for CRP level as a predictor of septic complications was observed on post-operative day (POD) 3, where CRP concentration > 200 mg/l had a sensitivity of 68% and a specificity of 74%. WBC measurements showed the best cut-off value on POD 2, where WBC > 12 × 10(9) had a sensitivity of 90% and a specificity of 62%.

Conclusion: The insufficient diagnostic accuracy of the levels of CRP and WBC made them weak diagnostic markers in prediction of post-operative septic complications, including anastomotic leakage, in the first three post-operative days after laparoscopic colorectal surgery.