• Michelle L Ramanathan, Graham MacKay, Jonathan Platt, Paul G Horgan, and Donald C McMillan.
• Academic Department of Surgery, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK, michelle.ramanathan@gmail.com.
• Ann. Surg. Oncol. 2015 Mar 1; 22 (3): 938-43.

BackgroundThere is increasing evidence that C-reactive protein is a useful negative predictor of infective complications and anastomotic leak following surgery for colorectal cancer. In particular, C-reactive protein concentrations on postoperative days 3 and 4 have been proposed to be of clinical utility since they aid safe and early discharge of selected patients following colorectal surgery. However, it is not clear whether such thresholds are also applicable in laparoscopic surgery. The aim of the present study was to compare the value of daily C-reactive protein concentrations in the prediction of postoperative infective complications in patients undergoing open versus laparoscopic resection for colon cancer.MethodsPatients with histologically proven colon cancer who were considered to have undergone potentially curative resection in one of two university teaching hospitals in Glasgow were included in the study (n = 344). Patient characteristics were collected in a prospective surgical database. All resections were elective cases and were performed using either open (n = 191) or laparoscopic surgery (n = 153). Daily blood samples to measure C-reactive protein concentrations perioperatively were taken routinely. Patients were assessed for postoperative infective and non-infective complications.ResultsThe majority of patients were aged 65 years or older (75%), male (52%), had left-sided tumors (54%), node negative disease (77%), and did not undergo neoadjuvant treatment (94%). Patients undergoing open and laparoscopic resection were similar in terms of age, sex, tumor site, TNM stage, comorbidity, and infective complications. In contrast, preoperative and postoperative days 1-3 C-reactive protein concentrations were lower following laparoscopic compared with open resection in the whole cohort (n = 344; all p < 0.001) and in those who did not develop infective complications (n = 251; all p < 0.001). The median length of hospital stay was shorter in the laparoscopic resection (p < 0.001). During follow-up, 127 (37%) patients developed a postoperative complication, 93 (73%) of which were infective complications. In those who developed an infective complication, there was no significant difference in the C-reactive protein concentrations between open and laparoscopic resections on postoperative days 1-4. C-reactive protein thresholds predictive of infective complications were the same on postoperative days 3 (180 mg/l) and 4 (140 mg/l) following both open and laparoscopic resection for colon cancer.ConclusionsThe results of the present study show that although the magnitude of the systemic inflammatory response, as evidenced by C-reactive protein, following surgery was greater in open compared with laparoscopic resection, the threshold concentrations of C-reactive protein for the development of postoperative infective complications were remarkably similar on days 3 and 4.

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