Proteína C reactiva como predictor de fuga anastomótica en cirugía colorrectal. Comparación entre cirugía abierta y laparoscópica / C reactive protein as a predictor of anastomotic leakage in colorectal surgery. Comparison between open and laparoscopic surgery

Introducción: La fuga anastomótica (FA) es una complicación seria en cirugía colorrectal, dado que conlleva un aumento de la morbimortalidad. El objetivo de este estudio prospectivo no aleatorizado es determinar si la proteína C reactiva (PCR) es útil como predictor de FA en pacientes intervenidos por vía laparoscópica versus cirugía abierta. Métodos: Se incluyeron 168 pacientes intervenidos de manera electiva por enfermedad colorrectal. La PCR fue medida diariamente en los 5 primeros días del postoperatorio. Se analizaron las complicaciones y, especialmente, la FA. Resultados: Presentaron complicaciones 32 (45,7%) pacientes del abordaje abierto, 15 (18,7%) del laparoscópico y 12 (29,4%) en el grupo de convertidos a cirugía abierta (p = 0,002). Desarrollaron FA 9 pacientes del abordaje abierto, 5 de los del laparoscópico y ninguno del grupo que hubo que convertir (p = 0,15). Hubo diferencias estadísticamente significativas de los valores de PCR entre los 3 grupos (p = 0,03). Las curvas ROC mostraron un área bajo la curva (ABC) en el día 3 para el abordaje abierto y laparoscópico de 0,731 y 0,760, respectivamente. En el día 4 obtuvimos un ABC de 0,867 en el abierto y de 0,914 en el laparoscópico. Los puntos de corte en el día 4 fueron: en abierto 159,2 mg/L; sensibilidad 75%, especificidad 89% y valor predictivo negativo (VPN) de 96% (p < 0,001). En el laparoscópico fue de 67,3mg/L; sensibilidad 100%, especificidad 89,5% y VPN de 100% (p = 0,016). Conclusiones: La PCR en el cuarto día postoperatorio es útil para diagnosticar FA; se deben tener en cuenta los diferentes puntos de corte en función del abordaje quirúrgico utilizado (AU)

Introduction: Anastomotic leak (AL) is a serious complication in colorectal surgery due to its increase in morbidity and mortality. The aim of this prospective non-randomised study is to determine whether C-reactive Protein (CRP) is useful as a predictor of AL in patients undergoing open versus laparoscopic surgery. Methods: A total of 168 patients undergoing elective colorectal surgery were included. CRP was measured daily during the first 5 postoperative days. Complications, specially AL, were analysed. Results: Following an open approach 32 patients (45.7%) presented complications, 15 (18.7%) in the laparoscopic group and 12 (29.4%) in the converted group (P=0.153). Following open surgery 9 patients experienced AL, 5 were detected in the laparoscopic group and none in those converted (P=0.153). There were significant differences in CRP values between the 3 groups (P=0.03). ROC Curves showed AUC for the open and laparoscopic approach of 0.731 and 0.760 respectively. On day 4 the AUC was 0.867 for the open group and 0.914 for the laparoscopic group. Cut-off points on day 4 were: Open: 159.2 mg/L; sensitivity 75%, specificity 89% and NPP 96% (P<0.001). Following laparoscopic surgery the cut-off point was 67.3%; sensitivity 100%, specificity 89.5% and NPP 100% (P=0.016). Conclusion: CRP on day 4 is useful to diagnose AL. Different cut-off values should be taken into account depending on the approach used (AU)

C reactive protein as a predictor of anastomotic leakage in colorectal surgery. Comparison between open and laparoscopic surgery. / Proteína C reactiva como predictor de fuga anastomótica en cirugía colorrectal. Comparación entre cirugía abierta y laparoscópica.

INTRODUCTION: Anastomotic leak (AL) is a serious complication in colorectal surgery due to its increase in morbidity and mortality. The aim of this prospective non-randomised study is to determine whether C-reactive Protein (CRP) is useful as a predictor of AL in patients undergoing open versus laparoscopic surgery. METHODS: A total of 168 patients undergoing elective colorectal surgery were included. CRP was measured daily during the first 5postoperative days. Complications, specially AL, were analysed. RESULTS: Following an open approach 32 patients (45.7%) presented complications, 15 (18.7%) in the laparoscopic group and 12 (29.4%) in the converted group (P=0.153). Following open surgery 9 patients experienced AL, 5 were detected in the laparoscopic group and none in those converted (P=0.153). There were significant differences in CRP values between the 3 groups (P=0.03). ROC Curves showed AUC for the open and laparoscopic approach of 0.731 and 0.760 respectively. On day 4 the AUC was 0.867 for the open group and 0.914 for the laparoscopic group. Cut-off points on day 4 were: Open: 159.2mg/L; sensitivity 75%, specificity 89% and NPP 96% (P<0.001). Following laparoscopic surgery the cut-off point was 67.3%; sensitivity 100%, specificity 89.5% and NPP 100% (P=0.016). CONCLUSION: CRP on day 4 is useful to diagnose AL. Different cut-off values should be taken into account depending on the approach used.

Factors that influence treatment delay in patients with colorectal cancer.

A prospective study was performed of patients diagnosed with colorectal cancer (CRC), distinguishing between colonic and rectal location, to determine the factors that may provoke a delay in the first treatment (DFT) provided.2749 patients diagnosed with CRC were studied. The study population was recruited between June 2010 and December 2012. DFT is defined as time elapsed between diagnosis and first treatment exceeding 30 days.Excessive treatment delay was recorded in 65.5% of the cases, and was more prevalent among rectal cancer patients. Independent predictor variables of DFT in colon cancer patients were a low level of education, small tumour, ex-smoker, asymptomatic at diagnosis and following the application of screening. Among rectal cancer patients, the corresponding factors were primary school education and being asymptomatic.We conclude that treatment delay in CRC patients is affected not only by clinicopathological factors, but also by sociocultural ones. Greater attention should be paid by the healthcare provider to social groups with less formal education, in order to optimise treatment attention.