C-reactive protein values after surgery for inflammatory bowel disease: is it still a good marker for intra-abdominal complication? A retrospective cohort study of 347 procedures : CRP after inflammatory bowel disease surgery.

PURPOSE: C-reactive protein (CRP) is a useful predictive test to early detect abdominal complication after colorectal surgery. Inflammatory bowel disease (IBD) is responsible for chronic inflammation and abnormal basal CRP that could influence the interest of its management after abdominal surgery. The aim of this study is to evaluate CRP as an indicator of postoperative complication in a specific IBD population. METHODS: Retrospective study of patients undergoing ileocolic resection or ileal pouch-anal anastomosis for IBD between 2012 and 2019. RESULTS: Ileocolic resection represents 242 patients and ileal pouch-anal anastomosis 105 patients. CRP was significantly higher at an early (105.2 ± 56.0 vs 128.1 ± 69.8; p = 0.008) and late stage (112.9 ± 72.8 vs 185.3 ± 111.5; p < 0.0001) for patients having an intra-abdominal complication. A BMI > 25 kg/m2 (p = 0.04) and an open surgical approach (p = 0.009) were associated with higher CRP levels in the first postoperative days (POD). In multivariate analysis, preoperative steroid use (p = 0.06), CRP at POD 3 > 100 mg/L (p = 0.003), and a rise between CRP values (p = 0.007) at 48 h were significantly associated with intra-abdominal complication. A CRP at POD 1 < 75 mg/L was associated with a lower rate of intra-abdominal complication (p = 0.01). A score dividing patients into 3 groups according to these values showed significant differences in intra-abdominal complication and anastomotic leakage rates. CONCLUSION: CRP is a useful predictive marker to detect abdominal complication after surgery in IBD population. Measurement of CRP can help to reduce hospitalization stay and orientate towards complementary examinations.

Surgical management of pancreatic neuroendocrine tumors: an introduction.

Introduction: Neuroendocrine tumors of the pancreas (pNETs) represent only 1% to 2% of all pancreatic neoplasms. These tumors can be classified as functional or nonfunctional tumors; as sporadic or from a genetic origin; as neuroendocrine neoplasms or carcinoma. Over the last decade, diagnosis of pNETs has increased significantly mainly due to the widespread use of cross-sectional imaging. Those tumors are usually associated with a good prognosis. Surgery, the only curative option for those patients, should always be discussed, ideally in a multidisciplinary team setting.Areas covered: We discuss i), the preoperative management of pNETs and the importance of accurate diagnosis, localization, grading and staging with computed tomography, magnetic resonance imaging, endoscopic ultrasound, and nuclear medicine imaging; ii), surgical indications and iii), the surgical approach (standard pancreatectomy vs pancreatic-sparing surgery).Expert opinion: The treatment option of all patients presenting with pNETs should be discussed in a multidisciplinary team setting with surgeon's experienced in both pancreatic surgery and neuroendocrine tumor management. A complete preoperative imaging assessment - morphological and functional - must be performed. Surgery is usually recommended for functional pNETs, nonfunctional pNETs >2 cm (nf-pNETs) or for symptomatic nf-pNETs.