Biomarkers and anastomotic leakage in colorectal surgery: C‐reactive protein trajectory is the gold standard

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Anastomotic leakage is the most frequent major surgical complication following colorectal surgery, with reported rates that vary between 2 and 14%.1 The clinical importance of anastomotic leakage should not be underestimated, being associated with increased morbidity, mortality and cancer recurrence as well as decreased long‐term survival.3 Despite advances in surgical technology, the incidence and burden of anastomotic leakage does not appear to be decreasing. While attempting to avoid the complication of anastomotic leakage remains paramount, minimizing the complications associated with it is an equally important task. There is good evidence that early diagnosis of anastomotic leakage results in improvements in the outcomes of short‐term morbidity and mortality.3 Early diagnosis may also translate into improved longer term outcomes, such as decreasing the need for permanent stomas, and reducing cancer recurrence rates, as well as improving long‐term survival.6
Clinical signs of anastomotic leakage are generally unreliable and tend to present late,1 so in view of this, a number of tools have been assessed, for utility in diagnosing anastomotic leakage at an early stage. Imaging, peritoneal cytokine levels and serum biomarkers of inflammation have all been proposed as methods in order to provide early detection of anastomotic leakage.1
For the purpose of this study, we chose four inflammatory serum biomarkers: C‐reactive protein (CRP), procalcitonin (PCT), white cell count (WCC) and gamma‐glutamyl transferase (GGT) and sought to assess their utility with respect to reliably predicting colorectal anastomotic leakage. In particular, we sought to determine whether the rate of change, or trajectory, of these biomarkers was predictive of anastomotic leak as defined by the need for intervention with surgery or radiological drainage.
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