Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection

被引:96
作者
Matthiessen, P. [1 ]
Henriksson, M.
Hallbook, O.
Grunditz, E.
Noren, B.
Arbman, G.
机构
[1] Orebro Univ Hosp, Dept Surg, S-70185 Orebro, Sweden
[2] Orebro Univ Hosp, Dept Radiol, Orebro, Sweden
[3] Linkoping Univ Hosp, Dept Surg, S-58185 Linkoping, Sweden
[4] Vrinnevi Hosp, Dept Radiol, Norrkoping, Sweden
[5] Linkoping Univ Hosp, Dept Radiol, Linkoping, Sweden
[6] Vrinnevi Hosp, Dept Surg, Norrkoping, Sweden
关键词
rectal cancer; anastomotic leakage; C-reactive protein; white blood cell count; pelvic fluid collection; CT-scan;
D O I
10.1111/j.1463-1318.2007.01300.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Objective This prospective study investigated the factors which might indicate anastomotic leakage after low anterior resection. Method Thirty-three patients who underwent anterior resection for rectal carcinoma (n = 32) and severe dysplasia (n = 1), were monitored daily by serum C-reactive protein (CRP) and white blood cell count (WBC) estimations until discharge from hospital. Computed tomography (CT) scans were performed on postoperative days 2 and 7 and the amount of presacral fluid collection was assessed. All patients had a pelvic drain and the volume of drainage was measured daily. Results The level of the anastomosis was at a median 5 cm (3-12 cm) above the anal verge. There was no 30-day mortality. Nine (27.2%) of the 33 patients developed a symptomatic anastomotic leakage which was diagnosed at a median of 8 days (range 4-14) postoperatively. The serum CRP was increased in patients who leaked from postoperative day 2 onwards (P = 0.004 on day 2; P < 0.001 on day 3-8). The WBC was decreased in preoperatively irradiated patients on days 1-5 (P <= 0.021), with no difference seen between patients with or without leakage. Patients with leakage had a larger presacral fluid collection on CT on day 7 (median 76 ml vs 52 ml; P = 0.016) and a larger increase in the fluid collection between the first and the second CT examinations (28 ml vs 3 ml; P = 0.046). Conclusion An early rise in serum CRP was a strong indicator of leakage. Monitoring of CRP for possible early detection of symptomatic anastomotic leakage is recommended.
引用
收藏
页码:75 / 80
页数:6
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