C-protein Reactive for the Detection of Anastomotic Leakage After Surgery for Digestive Cancer
C-protein Reactive for the Detection of Anastomotic Leakage After Surgery for Digestive Cancer
The aim of this study is to investigate the diagnostic accuracy of the C Protein Reactive
 (CRP) for the detection of Anastomotic leakage after surgery for digestive cancer. The
 standard protocol in our unit is to measure the CRP on the second and fourth postoperative
 day.

 The main aim of the study is to investigate the diagnostic accuracy of the ratio CRP on the
 fourth postoperative day on CRP on the second postoperative day (CRP_D4/CRP_D2). Secondary
 outcomes are the diagnosis accuracy of the CRP_D4 and CRP_D2.
The occurrence of anastomotic fistula (AF) is the most feared complication after digestive
 cancer surgery. It is responsible for high morbidity and accounts for more than a third of
 the deaths observed. The rate of anastomotic fistula reported in the literature varies
 between 1 and 40% according to the definition chosen by the authors. In the literature, the
 occurrence of the anastomotic fistula is responsible for a mortality rate of 4% and an
 overall morbidity of 35%. In the short term, the anastomotic fistula can put the patient's
 vital prognosis at risk by its septic consequences. Also, it is responsible for increasing
 the length of stay and costs. In the longer term, anastomotic fistula affects the functional
 prognosis of the patient as well as oncology in patients operated for cancer.

 Early rehabilitation becomes a standard in colorectal surgery, with exits around the 5th
 postoperative day. Anastomotic fistulas and their complications may appear well beyond. The
 diagnosis is made on average around 6-7 postoperative days. At an early stage, clinical signs
 are inconsistent and not very specific. Anastomotic fistula can manifest itself in a variety
 of clinical presentations, ranging from no symptoms to life-threatening septic shock. Routine
 imaging is neither reliable nor cost-effective for the detection of anastomotic fistulas and
 has the disadvantage of radiation.

 It is necessary to find an intraperitoneal infection marker with a high negative predictive
 value. This is particularly important in the era of early rehabilitation, allowing for safe
 patient discharge with a low risk of readmission. C-reactive protein (CRP) has already shown
 its utility in the early detection of infections after digestive surgery, however, because of
 conflicting results, no clear recommendations are established in the literature.

 Our study aims are to investigate the diagnostic accuracy of the postoperative CRP trajectory
 as an approach to eliminate the diagnosis of anastomotic fistula and to try to establish an
 optimal threshold with high sensitivity and negative predictive value.
Inclusion Criteria:

 -  Surgical resection for digestive cancer

 -  Creation of anastomosis.

 -  at least one measurement of CRP at the second and/or fourth postoperative day.

 Exclusion Criteria:

 -  Surgical resection without anastomosis creation

 -  No measurement of CRP on the second or the fourth postoperative day.