Clinical Value Of C-reactive Protein In Early Prediction Of Anastomotic Leakage After Laparoscopic Rectal Cancer Surgery

Objective:To study the accuracy and reference range of C-reactive protein(CRP)in early prediction of anastomotic leakage after primary suture in laparoscopic resection of rectal cancer.Methods:From June 2018 to June 2019,patients with rectal cancer who were diagnosed by gastrointestinal surgery in the Second Affiliated Hospital of Nanchang University and underwent laparoscopic resection of rectal cancer were retrospectively analyzed.After operation,they were divided into anastomotic leakage group(observation group)and non anastomotic leakage group(control group)based on whether there were anastomotic leakage.Univariate analysis was used to analyze the several preoperative factors that may cause postoperative anastomotic leakage.The differences of serum CRP and WBC levels at different time between the two groups were compared.The sensitivity and specificity of CRP were calculated according to the receiver operating characteristic curve(ROC).The optimal critical value is calculated by Youden index.The positive predictive value and negative predictive value were calculated.Results:In this study,10 cases(12.2%)of 82 patients had anastomotic leakage,and the patients were cured and discharged after different treatment methods.To Compared with the clinical data of the two groups,univariate analysis showed that there was no significant difference in gender,age,body mass index(BMI),pathological stage,diabetes mellitus,hypertension and anastomotic leakage(P > 0.05).And there was no obvious difference in the serum white blood cell(WBC)levels between the two groups before and on the 1st after operation(P > 0.05),but there was difference on the 3rd,5th and 8th day after operation.Meanwhile the C-reactive protein(CPR)value in the anastomotic leakage group was higher than that in the non anastomotic leakage group on the 1st,3rd and 5th day after operation,and the difference was statistically significant(P < 0.05),but have no different on the 8th day(P = 0.051).According to the receiver operating characteristic(ROC)curve,the AUC(Area size below ROC curve)was highest on the 3rd day after operation,Youden index showed that the critical value of C-reactive protein was 109 mg/L.The positive predictive value was 44.4%,and the negative predictive value was 96.7%.Conclusion:After the laparoscopic resection of rectal cancer,if the serum CRP level remains high or rising gradually and the CRP≥109mg/L on the 3rd to 5th day after operation by excluding other infections in the perioperative period and the interference of acute cerebral infarction,myocardial infarction and pulmonary embolism after operation,it is highly suspected that the leakage of anastomotic.If necessary,we should combine imaging examination to judge and clinical intervene as soon as possible.