The marker C-reactive protein is helpful in monitoring the integrity of anastomosis: plasma calprotectin

Cikot, Murat; Köneş, Osman; Gedikbaşı, Asuman; Kocataş, Ali; Karabulut, Mehmet; Temizgönül, Kaplan Baha; Alış, Halil

doi:10.1016/j.amjsurg.2015.06.018

Cited by 7 publications

(7 citation statements)

References 36 publications

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“…An earlier study by Reisinger et al [21] showed higher calprotectin levels on postoperative day 2, 3, 4, and 5 in patients who developed AL. Similar results were found by Cikot et al [33]. In the current study however, no statistical difference in serum calprotectin levels could be found between patients with and without anastomotic leakage on postoperative day 1, 3, or 5.…”

Section: Discussionsupporting

confidence: 90%

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

et al. 2019

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ObjectiveNear-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL.MethodsPatients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon’s judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded.ResultsThirty patients (n = 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal—(n = 10), rectosigmoid—(n = 2), sigmoid—(n = 10), or more proximal colon carcinomas (n = 8). Five patients (16.7%) developed AL (n = 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P = 0.02) and a lower FI compared to background FI was measured at 1st assessment (P = 0.039). However, no relation between FI and postoperative inflammatory parameters could be found.ConclusionBoth subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.

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Section: Discussionsupporting

confidence: 90%

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

et al. 2019

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“…Despite advances in surgical techniques and stapling devices, anastomotic leakage remains one of the most devastating complications of colorectal surgery 1,2 with mortality rates reaching 30% 3 . The incidence of anastomotic leakage varies from 1% to 30% 4 , and it is most common in extraperitoneal anastomosis 2,5,6 .…”

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confidence: 99%

“…Early diagnosis is essential to reduce mortality, length of hospital stay, postoperative complications, tumour recurrence, and costs 1,5 . Because of the high mortality rate 4 , scores were developed to help identify patients at high risk for this complication 13 .…”

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confidence: 99%

Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Messias¹,

Botelho

Saad

et al. 2020

Sci Rep

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Anastomotic leakage is a complication of colorectal surgery. c-reactive protein (cRp) is an acutephase marker that can indicate surgical complications. We determined whether serum cRp levels in patients who had undergone colorectal surgery can be used to exclude the presence of anastomotic leakage and allow safe early discharge. We included 90 patients who underwent colorectal surgery with primary anastomosis. Serum cRp levels were measured retrospectively on postoperative days (poDs) 1-7. Patients with anastomotic leakage (n = 11) were compared to those without leakage (n = 79). We statistically analysed data and plotted receiver operating characteristic curves. the incidence of anastomotic leakage was 12.2%. Diagnoses were made on PODs 3-24. The overall mortality rate was 3.3% (18.2% in the leakage group, 1.3% in the non-leakage group; P < 0.045). CRP levels were most accurate on POD 4, with a cutoff level of 180 mg/L, showing an area under the curve of 0.821 and a negative predictive value of 97.2%. Lower CRP levels after POD 2 and levels <180 mg/L on POD 4 may indicate the absence of anastomotic leakage and may allow safe discharge of patients who had undergone colorectal surgery with primary anastomosis.

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“…Similar results have been seen in a further study which identified raised pre-operative and post-operative calprotectin levels on the 1st, 3rd and 5th days following surgery in patients which developed an AL, whereas CRP levels only became elevated on the 3rd and 5th days, with no WBCC changes being observed. The authors again suggested that combined calprotectin and CRP assessment might aid early AL diagnosis [206].…”

Section: Leukocytes Neutrophils and Intestinal Damage Markersmentioning

confidence: 99%

Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients

Gray

Marland

Murray

et al. 2021

JPM

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Development of an anastomotic leak (AL) following intestinal surgery for the treatment of colorectal cancers is a life-threatening complication. Failure of the anastomosis to heal correctly can lead to contamination of the abdomen with intestinal contents and the development of peritonitis. The additional care that these patients require is associated with longer hospitalisation stays and increased economic costs. Patients also have higher morbidity and mortality rates and poorer oncological prognosis. Unfortunately, current practices for AL diagnosis are non-specific, which may delay diagnosis and have a negative impact on patient outcome. To overcome these issues, research is continuing to identify AL diagnostic or predictive biomarkers. In this review, we highlight promising candidate biomarkers including ischaemic metabolites, inflammatory markers and bacteria. Although research has focused on the use of blood or peritoneal fluid samples, we describe the use of implantable medical devices that have been designed to measure biomarkers in peri-anastomotic tissue. Biomarkers that can be used in conjunction with clinical status, routine haematological and biochemical analysis and imaging have the potential to help to deliver a precision medicine package that could significantly enhance a patient’s post-operative care and improve outcomes. Although no AL biomarker has yet been validated in large-scale clinical trials, there is confidence that personalised medicine, through biomarker analysis, could be realised for colorectal cancer intestinal resection and anastomosis patients in the years to come.

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The marker C-reactive protein is helpful in monitoring the integrity of anastomosis: plasma calprotectin

Cited by 7 publications

References 36 publications

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery

Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients

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