Annals of Coloproctology

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Original Article

Complication

Early warning model to detect anastomotic leakage following colon surgery: a clinical observational study: Pooya Rajabaleyan, Ravish Jootun, Sören Möller, Ulrik Deding, Mark Bremholm Ellebæk, Issam al-Najami, Ian Lindsey; Ann Coloproctol. 2024;40(5):431-439. Published online October 8, 2024; DOI: https://doi.org/10.3393/ac.2023.00745.0106

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Purpose
We aimed to develop a predictive tool for anastomotic leakage (AL) following colon cancer surgery by combining a clinical early warning score (EWS) with the C-reactive protein (CRP) level.
Methods
The records of 1,855 patients who underwent colon cancer surgery at the Oxford University Hospitals NHS Foundation Trust between January 2013 and December 2018, with or without AL, were retrospectively reviewed. EWS and CRP levels were assessed daily from the first postoperative day until discharge. AL was defined as an anastomotic defect observed at reoperation, the presence of feculent fluid in a pelvic drain, or evidence of AL on computed tomography. The tool incorporated postoperative EWS and CRP levels for the accurate early detection of AL.
Results
From postoperative days 3 to 7, the mean CRP level exceeded 200 mg/L in patients with AL and was under 200 mg/L in those without AL (P<0.05). From postoperative days 1 to 5, the mean EWS among patients with leakage exceeded 2, while scores were below 2 among those without leakage (P<0.05). Receiver operating characteristic curve analysis identified postoperative day 3 as the most predictive of early leakage, with cutoff values of 2.4 for EWS and 180 mg/L for CRP; this yielded an area under the curve of 0.87 (sensitivity, 90%; specificity, 70%).
Conclusion
We propose using an EWS of 2.4 and a CRP level of 180 mg/L on postoperative day 3 following colon surgery with anastomosis as threshold values to prompt investigation and treatment of AL.

Citations

Citations to this article as recorded by

The Clinical Presentation of Anastomotic Leakage Compared Between CRS-HIPEC and Conventional Colorectal Surgery
M. Cats, L. G. Magermans, E. C. E. Wassenaar, A. A. W. van Geloven, M. J. Wiezer, J. D. J. Plate, D. Boerma
Annals of Surgical Oncology.2026; 33(2): 1706. CrossRef
Anastomotic leak in colorectal surgery: Current evidence on risk, diagnosis, preventive measures and management
Ali Akbar Shah, Gevorg Manoukian, Omar Yasin, Amy Jacob, Timothy M. Kopah, Jas Simran Gill, Ruthel Rose, Bashayer Khaled Alharbi, Sana Zafar
Surgical Practice.2026;[Epub] CrossRef
Late Anastomotic Leakage After Rectal Cancer Surgery: Incidence and Differential Risk Factors
Hyeon Kyeong Kim, In Ja Park, Jae Cheol Kang, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim
Diseases of the Colon & Rectum.2026; 69(4): 565. CrossRef
Risk factor analysis and nomogram model development for anastomotic leakage following laparoscopic radical colorectal cancer surgery
Zi-Hong He, Yang-Yang Zhou, Ruo-Nan Zhang, Yu-Shen He, Yan-Hong Jin, Fu-Hao Tian
World Journal of Surgical Oncology.2026;[Epub] CrossRef
‘Failure to rescue’ from anastomotic leak following colorectal cancer resection: An observational study from a binational registry
Cameron I. Wells, Wal Baraza, Greg O'Grady, Ian P. Bissett
Colorectal Disease.2025;[Epub] CrossRef
Unplanned intensive care unit admission after elective colon cancer resection: population-based registry study
Sofia Dahlberg, Tomas Vedin, Ingvar Syk, Emma Larsson, Niklas Nielsen, Henrik Bergenfeldt
BJS Open.2025;[Epub] CrossRef
Early detection of anastomotic leakage in colon cancer surgery: the role of early warning score and C-reactive protein
Gyung Mo Son
Annals of Coloproctology.2024; 40(5): 415. CrossRef
Predictive Biomarkers for the Early Detection of Anastomotic Leaks in Colorectal Surgeries: A Systematic Review
Wahidullah Dost, Mohammad Qaher Rasully , Mohammad Nazir Zaman, Wahida Dost, Wahida Ali, Sami A Ayobi, Raisa Dost, Jamaluddin Niazi, Kinza Bakht, Asma Iqbal, Syed Faqeer Hussain Bokhari
Cureus.2024;[Epub] CrossRef

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