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Background: Infective complications represent a major cause of morbidity after colorectal cancer resection. Diagnosis is often late, when the patient is exhibiting signs of sepsis. Although it is known that C-reactive protein (CRP) is a sensitive marker of inflammation, it is unclear whether it could be used for early identification of patients developing postoperative infective complications. We analysed the diagnostic accuracy of serial serum CRP levels to detect infective complications after colorectal cancer resection.Patients and Methods: CRP was routinely measured perioperatively in 477 consecutive patients undergoing colorectal cancer resection with curative intent. Postoperative complications were recorded using clinical, laboratory and radiological data. Median CRP results were compared using the Mann-Whitney U test. The diagnostic accuracy of CRP was analysed by receiver operating characteristics (ROC) curve analysis. On follow up, 125 patients developed postoperative infective complications (28 intraabdominal, 97 extraabdominal) in the first 14 days.Results: The uncomplicated patients CRP peaked on postoperative day 2 (POD 2), with a median CRP of 170mg/L and gradually decreased thereafter. In contrast, although the patients with infective complications CRP also peaked on POD 2 (median 213mg/L), it remained elevated thereafter. The CRP was significantly higher in the infective complication group from POD 2 until POD 7 (p<0.001). ROC analysis demonstrated that the increased CRP levels on POD 3 were associated with postoperative infections. The optimal cut off value was 180 (sensitivity 73%, specificity 73%). The area under the ROC curve was 0.77 (p<0.001). For those with intraabdominal infections, the area under the curve was 0.83 (p<0.001).Conclusions: Serial CRP measurements are useful in the early detection of postoperative infections following colorectal cancer resection. An elevated CRP value greater than 180 mg/L on POD 3 should be investigated.