EP780 - Correlation between post-operative C-reactive protein levels and post-operative short-term outcomes after colorectal resection.

Purpose/Background: Colorectal cancer surgery carries a risk of postoperative complications that can impact recovery and prognosis. Early detection represents the key to improving outcomes. C-reactive protein (CRP), an acute-phase inflammatory marker, is inexpensive and easy to measure. Studies have linked postoperative CRP levels to complications, but few specify timing. This study aimed to evaluate the correlation between CRP levels and their postoperative changes with the occurrence of complications.

Methods/Interventions: The study had a retrospective single-center design. Patients who underwent to colorectal resection for cancer or benignant disease at Isola Tiberina Gemelli Isola Hospital between July 2022 and March 2024 were enrolled. A standardized surgical procedures and postoperative managements were adopted. Baseline characteristics of patients, surgical procedures, postoperative outcomes within 30 days from surgery (defined according Clavien-Dindo classification and classified as major if grade III or higher) and CRP levels on postoperative day (POD) 1,3 and, if indicated, 5 were recorded in a prospective database. Moreover, the variation () between CRP levels on POD3 and POD1, POD5 and POD3, POD5 and POD1 were calculated. A statistical analysis was performed to evaluate the correlation between CRP value and its variation with the occurrence of a postoperative complication. Moreover, a univariate and multivariate analysis were performed to identify predictive factors for occurrence of overall and major morbidity.

Results/Outcomes: Fourty-hundred sixty-one patients (238 males; median age 71 years) entered the study. The majority (68.5%) of patients underwent surgery for colorectal cancer and right colon was the more frequent tumor site (37.66%). A mini-invasive approach was adopted in 91.76% of cases with a conversion rate of 5.2%. The overall postoperative morbidity, major morbidity and anastomotic leak rates were respectively 31.67%, 7.59% and 3.69%. The postoperative mortality rate was 0.65% and the median length of stay was 5 days. In all patients CRP levels was dosed on POD1 and POD3; CRP level on POD5 was dosed only in 193 cases as clinically indicated. A CRP levels higher than IQ3 on POD3 (12.26 mg/dL) and on CRP POD3-POD1 were the PCR related variables more significantly related to overall morbidity, major morbidity, anastomotic leak, postoperative mortality and prolonged in hospital stay. At statistical univariate and multivariate analysis on predictive factors for overall and major morbidity value of CRP POD3-POD1 higher than +6.95 and CRP on POD3 higher than 12.26 mg/dL were the most strictly related to the occurrence of a complication. The diagnostic accuracy of higher value (>IQ3) of CRP POD3-POD1 and CRP POD3 in predicting overall morbidity, major morbidity and anastomotic leak was respectively 70.5%, 79.83% and 81.13%.

Conclusion/Discussion: High CRP POD3 levels and a high increase of CRP level between POD1 and POD3 seems to be strictly associated to the occurrence of postoperative complication after colorectal resection. The routinely dose of CRP level during the postoperative period after colorectal resection could be very useful for identifying at-risk patients for severe postoperative morbidity.

Table 1 - Baseline characteristics and CPR levels
Relationship between CRP levels and postoperative outcomes