ROLE OF C-REACTIVE PROTEIN IN PREDICTING EARLY POSTOPERATIVE LEAK IN COLORECTAL ANASTOMOSIS: A PROSPECTIVE OBSERVATIONAL STUDY

Abstract

Background: Anastomotic leak remains one of the most serious complications following colorectal surgery and is associated with significant morbidity, mortality, prolonged hospital stay, reoperation, and increased healthcare costs. Early diagnosis is often difficult because clinical signs may be subtle in the initial postoperative period. C reactive protein (CRP), an acute phase reactant, has been proposed as an early biochemical marker for the detection of anastomotic leak. Aim: To evaluate the role of serial postoperative CRP measurements on postoperative day (POD) 3, POD 4, and POD 5 in predicting early colorectal anastomotic leak. Methods: This prospective observational study was conducted in the Department of Surgical Gastroenterology between June 2022 and March 2025. A total of 150 patients undergoing colorectal resection with primary anastomosis were included. Serum CRP levels were measured on POD 3, POD 4, and POD 5. Patients were monitored clinically for evidence of anastomotic leak. Patients with rising CRP trends underwent early contrast enhanced computed tomography (CECT). The association between CRP trend and postoperative leak was analyzed. Results: Among 150 patients, 147 (98%) showed a decreasing CRP trend from POD 3 to POD 5 and had an uneventful postoperative course. Three patients (2%) demonstrated progressively increasing CRP values and subsequently developed anastomotic leak confirmed by CECT and re-exploration. Mean CRP values in the no leak group decreased from 124.3 ± 6.2 mg/L on POD 3 to 70.8 ± 6.4 mg/L on POD 5, whereas in the leak group CRP increased from 117.7 ± 7.5 mg/L to 196.7 ± 12.1 mg/L. Rising CRP trend was significantly associated with anastomotic leak (p <0.001).