The value of C-reactive protein, leucocytes and vital signs in detecting major complications after oncological colorectal surgery.

PURPOSE: To assess the association of postoperative C-reactive protein (CRP), leucocytes and vital signs in the first three postoperative days (PODs) with major complications after oncological colorectal resections in a tertiary referral centre for colorectal cancer in The Netherlands. METHODS: A retrospective cohort study, including 594 consecutive patients who underwent an oncological colorectal resection at Maastricht University Medical Centre between January 2016 and December 2020. Descriptive analyses of patient characteristics were performed. Logistic regression models were used to assess associations of leucocytes, CRP and Modified Early Warning Score (MEWS) at PODs 1-3 with major complications. Receiver operating characteristic curve analyses were used to establish cut-off values for CRP. RESULTS: A total of 364 (61.3%) patients have recovered without any postoperative complications, 134 (22.6%) patients have encountered minor complications and 96 (16.2%) developed major complications. CRP levels reached their peak on POD 2, with a mean value of 155 mg/L. This peak was significantly higher in patients with more advanced stages of disease and patients undergoing open procedures, regardless of complications. A cut-off value of 170 mg/L was established for CRP on POD 2 and 152 mg/L on POD 3. Leucocytes and MEWS also demonstrated a peak on POD 2 for patients with major complications. CONCLUSIONS: Statistically significant associations were found for CRP, Δ CRP, Δ leucocytes and MEWS with major complications on POD 2. Patients with CRP levels ≥ 170 mg/L on POD 2 should be carefully evaluated, as this may indicate an increased risk of developing major complications.

Sigmoidorectal intussusception caused by colon carcinoma.

Intussusception, the invagination of a bowel segment into an adjacent segment, occurs in 5% of adult patients with an obstruction of the bowel. It is often seen as a result of obstructive defecation syndrome or malignancy. However, a sigmoidal malignancy as lead point is rare. Symptoms in adults are less specific than in children, which makes preoperative diagnosis challenging. An 85-year-old female presented with bright red anal blood loss. A large palpable mass was found during rectal examination. A computed tomography was performed during workup, which showed a 'target-sign' on the location of the lesion. An intussusception of the sigmoid into the rectum was seen over the length of 15 cm. This particular type of intussusception is extremely rare. When a neoplasm is suspected to be the lead point, an oncological resection is recommended. We performed a total mesorectal excision, after which the patient had an uneventful recovery.