E-Posters

Abstract

Introduction: Serum C-reactive protein concentration (CRP) is a useful tool to detect an anastomotic leak after colorectal surgery. There was a continuous debate about the cut-off of CRP and the clinical applications of such cut-offs. Methods Patients who underwent an abdominal operation which involved an intestine anastomosis between December 2016 and October 2018 were included in the study. Post-operative dates (POD) were verified with the receipt times of the corresponding histopathology specimens on the electronic pathology system. Result 327 patients were recruited during the study period. 29 were excluded from the study and the reasons were illustrated in figure 1. There were 122 left-sided colonic resections, 117 ileocolic anastomoses, and 59 small intestine anastomoses. Indications of the procedures were illustrated in the following table. Among left-sided colonic anastomoses, the Receiver operating characteristic (ROC) curve was drawn with the anastomotic leakage as the state variable, and the CRP level as the detection variable. The area under the curve (AUC) was 0.52, 0.67, 0.79, 0.83 and 0.87, respectively. The calculated CRP ratio cut-offs of all the rest of PODs (2, 3, 4 and 5) were highly significant in the laparoscopic group and the overall group (p<0.001). Conclusion: Our cohort confirmed the incidence of anastomotic leaks in colorectal surgery. POD 3 CRP below 234mg/L, or CPR ratio (POD2/POD1) below 1.9 had a negative predictive value of 1 in open surgery (p=0.001 and <0.0001 respectively). CRP ratio enabled the early exclusion of an anastomotic leak and spared additional CRP.