Monitorización de Procalcitonina y Proteina-C-Reactiva¿Ha contribuido a disminuir el tiempo de reintervención en las complicaciones de la cirugía colorrectal?

  1. J. Rosales Goas 1
  2. J. Pérez Grobas 2
  3. C. Madarro Pena 1
  4. J.A. Abril Banet 1
  5. I. Baamonde de la Torre 1
  6. E. Martinez Rodriguez 1
  7. M. Diaz Tíe 1
  1. 1 Complejo Hospitalario Universitario de Ferrol ( A Coruña ).
  2. 2 Complejo Hospitalario Universitario de A Coruña.
Journal:
Cirugía Andaluza

ISSN: 2695-3811,  1130-3212

Year of publication: 2024

Volume: 35

Issue: 1

Pages: 18-24

Type: Article

DOI: 10.37351/2024351.3 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: Cirugía Andaluza

Abstract

Introduction: Currently, anastomosis dehiscence represents one of the major complications in both elective colorectal surgery and urgent surgery. This is associated with high morbidity and mortality, increased hospital stay, and greater consumption of resources. The search for acute phase reactants as inducers for the arrest and anticipation of anastomotic dehiscence after surgery continues to be studied. Procalcitonin and C-Reactive Protein are the markers used in our center to monitor postoperative complications. The need for reoperation and anastomotic dehiscence are two closely linked concepts; every Colorectal Surgery unit should know and follow protocols to carry out a more effective, efficient and safe treatment. Methods: Observational and retrospective study nested in a cohort of 435 patients operated on for colorectal cancer at the Complejo Hospitalario Universitario de Ferrol (CHUF) between 2017-2020. Statistical analysis consisted of contrast tests and regression models. Results:The incidence of anastomotic dehiscence was 7.59%; PCT and PCR measurement on the second and fourth postoperative day showed an upward trend in cases that required reintervention, especially PCR seriation which, in terms of Odd ratio (OR), implies 3.30 times more probability of said event. Conclusions: The PCT and PCR serialization on the second and fourth postoperative days did not have a great impact on the time until surgery. However, the increasing values of both PCR and PCT suggest the need for additional tests.

Bibliographic References

  • Lagoutte, N., O. Facy, A. Ravoire, C. Chalumeau, L. Jonval, P. Rat, y P. Ortega-Deballon. 2012. «C-Reactive Protein and Procalcitonin for the Early Detection of Anastomotic Leakage after Elective Colorectal Surgery: Pilot Study in 100 Patients». Journal of Visceral Surgery 149 (5): e345-49. https://doi.org/10.1016/j.jviscsurg.2012.09.003.
  • Navarrete E.B, Beltrán-García T.C., Mosquera M.F., Rojas V.M., Medina D.A.B., Avendaño C.E.F. 2020. «Procalcitonin as an Early Marker in the Detection of Anastomotic Intestinal Leak in a Universitary Hospital of Bogotá». Journal of Coloproctology 40 (04): 376-85. https://doi.org/10.1016/j.jcol.2020.07.005.
  • Svoboda P, Kantorová I, Scheer P, Radvanova J, Radvan M.2007. «Can Procalcitonin Help Us in Timing of Re-Intervention in Septic Patients after Multiple Trauma or Major Surgery?» Hepato-Gastroenterology 54 (74): 359-63.
  • Benedetti M., Ciano P., Pergolini I., Ciotti S., Guercioni G., Ruffo G., et al. Early diagnosis of anastomotic leakage after colorectal surgery by the Dutch leakage score, serum procalcitonin and serum C-reactive protein: study protocol of a prospective multicentre observational study by the Italian ColoRectal Anastomotic Leakage (iC. Il G Chir. 2019;40(1):20-25. https://doi.org/10.1002/bjs5.50269.
  • Tan W.J., Ng W.Q., Sultana R., Nisa de Souza N., Chew M.H., Foo F.J., et al.2018. «Systematic Review and Meta-Analysis of the Use of Serum Procalcitonin Levels to Predict Intra-Abdominal Infections after Colorectal Surgery». International Journal of Colorectal Disease 33 (2): 171-80. https://doi.org/10.1007/s00384-017-2956-8.
  • Gervaz, P., Platon A., Buchs N.C., Rocher T., Perneger T., Poletti P.A.2013. «CT Scan-Based Modelling of Anastomotic Leak Risk after Colorectal Surgery». Colorectal Disease: The Official Journal of the Association of Coloproctology of Great Britain and Ireland 15 (10): 1295-1300. https://doi.org/10.1111/codi.12305.
  • Cousin F., Ortega-Deballon P., Bourredjem A., Doussot A., Giaccaglia V., Fournel I.2016. «Diagnostic Accuracy of Procalcitonin and C-Reactive Protein for the Early Diagnosis of Intra-Abdominal Infection After Elective Colorectal Surgery: A Meta-Analysis». Annals of Surgery 264 (2): 252-56. https://doi.org/10.1097/SLA.0000000000001545.
  • Hayati F., Mohd Azman Z.A., Nasuruddin D.N., Mazlan L., Zakaria A.D., Sagap I.,2017. «Serum Procalcitonin Predicts Anastomotic Leaks in Colorectal Surgery». Asian Pacific Journal of Cancer Prevention 18 (7). https://doi.org/10.22034/APJCP.2017.18.7.1821.
  • Zawadzki M., Czarnecki R., Rzaca M., Obuszko Z., Velchuru V.R., Witkiewicz R.2015. «C-reactive protein and procalcitonin predict anastomotic leaks following colorectal cancer resections – a prospective study». Videosurgery and Other Miniinvasive Techniques 4: 567-73. https://doi.org/10.5114/wiitm.2015.56999.
  • The Italian ColoRectal Anastomotic Leakage (iCral) Study Group, Catarci M., Ruffo G., Borghi F., Patriti A., Delrio P., Scatizz M.i, et al.2020. «Anastomotic Leakage after Elective Colorectal Surgery: A Prospective Multicentre Observational Study on Use of the Dutch Leakage Score, Serum Procalcitonin and Serum C-reactive Protein for Diagnosis». BJS Open 4 (3): 499-507. https://doi.org/10.1002/bjs5.50269.
  • Gans S.L., Atema J.J., Van Dieren S., Groot Koerkamp B., Boermeester M.A.2015. «Diagnostic Value of C-Reactive Protein to Rule out Infectious Complications after Major Abdominal Surgery: A Systematic Review and Meta-Analysis». International Journal of Colorectal Disease 30 (7): 861-73. https://doi.org/10.1007/s00384-015-2205-y.
  • Olsen B.C., Sakkestad S.T, Pfeffer F., Karliczek A.2019. «Rate of Anastomotic Leakage After Rectal Anastomosis Depends on the Definition: Pelvic Abscesses Are Significant». Scandinavian Journal of Surgery: SJS: Official Organ for the Finnish Surgical Society and the Scandinavian Surgical Society 108 (3): 241-49. https://doi.org/10.1177/1457496918812223.
  • Guevara-Morales G.R., Regalado-Torres M.A., Cantarell-Castillo E., Castro-Salas R., Maldonado-Barrón R., Castellanos-Juárez J.C.2018.«Utility of C-reactive protein in the early diagnosis of anastomotic leakage in colorectal surgery».Cir Cir.(86):432-436. https://doi.org/10.24875/ciru.18000261.
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