C-reactive protein in predicting major postoperative complications are there differences in open and minimally invasive colorectal surgery? Substudy from a randomized clinical trial

Jennifer Straatman, Miguel A Cuesta, Jurriaan B Tuynman, Alexander A F A Veenhof, Willem A Bemelman, Donald L van der Peet, Jennifer Straatman, Miguel A Cuesta, Jurriaan B Tuynman, Alexander A F A Veenhof, Willem A Bemelman, Donald L van der Peet

Abstract

Background: In search of improvement of patient assessment in the postoperative phase, C-reactive protein (CRP) is increasingly being studied as an early marker for postoperative complications following major abdominal surgery. Several studies reported an attenuated immune response in minimally invasive surgery, which might affect interpretation of postoperative CRP levels. The aim of the present study was to compare the value of CRP as a predictor for major postoperative complications in patients undergoing open versus laparoscopic colorectal surgery.

Methods: A subgroup analysis from a randomized clinical trial (LAFA-trial) was performed, including all patients with non-metastasized colorectal cancer. In the LAFA trial, patients were randomized to open or laparoscopic segmental colectomy. In a subgroup of 79 patients of the LAFA trial, postoperative assessment of CRP levels was conducted routinely preoperatively and 1, 2, 24 and 72 h after surgery.

Results: Thirty-seven patients were randomized to the open group and 42 patients to the laparoscopic group. Major complications occurred in 19% of laparoscopic procedures and 13.5% of open procedures (p = 0.776). CRP levels rise following surgical procedures. In uncomplicated cases, the rise in CRP levels was significantly lower at 24 and 72 h following laparoscopic resection in comparison to open resection. No differences in CRP levels were observed when comparing open and laparoscopic resection in patients with major complications.

Conclusion: In patients with an uncomplicated postoperative course, CRP levels were lower following minimally invasive resection, possibly due to decreased operative trauma. No differences in CRP were observed stratified for surgical technique in patients with major complications. These results suggest that CRP may be applied as a marker for major postoperative complications in both open and minimally invasive colorectal surgery. Future research should aim to assess the role of standardized postoperative CRP measurements.

Keywords: C-reactive protein; Colorectal surgery; Minimally invasive surgery; Postoperative complications; Quality control.

Conflict of interest statement

Jennifer Straatman, Miguel A. Cuesta, Jurriaan B. Tuynman, Alexander F. A. A. Veenfhof, Willem A. Bemelman and Donald L. van der Peet declare no conflicts of interest or financial ties to disclose.

Figures

Fig. 1
Fig. 1
Flow chart for inclusion and analysis of patients
Fig. 2
Fig. 2
Postoperative median CRP levels in patients operated with minimally invasive or open techniques, stratified for major complications. Row A depicts p values for differences between open and minimally invasive surgery in patients with an uncomplicated or minor complicated postoperative course. Row B depicts p values in patients with major complications. p values were calculated using Mann–Whitney-U tests

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