Back to Program | 2010 Program and Abstracts Overview | 2010 Posters

Background: Intra-abdominal infective complications in form of anastomotic leaks or collection are clinically important complications following gastro-oesophageal cancer resection. Therefore, early detection is of paramount importance. Although markers of the systemic inflammatory response, including C-reactive protein (CRP) and white cell count (WCC), have been used in this regard but their relative predictive value is unclear. The aim of the present study was to examine serial post-operative WCC and CRP and their diagnostic accuracy in case of infective complications.Patients and Methods: CRP and WBC were routinely measured postoperatively in 136 consecutive patients undergoing gastro-oesophageal cancer resection. Postoperative complications were recorded. The diagnostic accuracy of CRP and WBC were analyzed by receiver operating characteristics (ROC) curve analysis with intra and extra-abdominal infectious complications as the outcome.Results: CRP peaked on postoperative day (POD) 2 with a median serum CRP of 206 mg/L, and gradually decreased thereafter in patients with an uncomplicated postoperative course. In intra-abdominal infective patients CRP was significantly greater, peaked on POD 3 (median CRP 237 mg/L), and persisted thereafter, whereas white blood cell count did not differ significantly from uneventful courses until POD 7. ROC analysis also showed the increased CRP levels on POD 3 were associated with intra-abdominal infections. The optimum cut-off value was 180 (sensitivity, 0.79; specificity, 0.59). The area under the ROC curve was 0.74 (p=0.001). On POD 4, 5 and 6, the diagnostic accuracy of CRP was similar.Conclusion: Serial CRP measurements are helpful for detecting intra-abdominal infections after gastro-oesophageal resection. Persistently elevated CRP values after POD 3 should be investigated for intra-abdominal infection.