CLINICAL ASPECTS AMT, v. II, no. 3, 2014, p. 275 THE SEPTIC COMPLICATIONS IN COLORECTAL SURGERY CAN MODIFY SERUM LEVELS OF C - REACTIVE PROTEIN IN EARLY TIME OF THE INCIDENCE? ROLAND KISS 1 , ALINA-SIMONA BEREANU 2 , MIHAI SAVA 3 , CSILLA KOVACS 4 , LORANT KISS 5 1,2 County Clinical Emergency Hospital of Sibiu, 3,4,5 “Lucian Blaga” University of Sibiu Keywords: anastomotic leakage, C-protein reactive, pneumonia Abstract: anastomotic leakage (AL) is a severe complication in colorectal surgery, and C-reactive protein (CRP) level can be a predictive marker of this complications. Material and method: this retrospective study analyses the evolution of 341 patients with colorectal cancer and primary anastomosis between 2003 and 2012, performed in the Ist Surgical Clinic, Emergency Academic Hospital Sibiu. Results: 7,3% of 341 patients developed AL, the mean day was 8,8 day postoperative of the patients with AL, 20 (80%) underwent reoperation, 20% of AL patients were treated conservatively. The high mortality in patients with AL (8%) caused by sepsis, versus 3,2% in larger group without AL and sepsis (p=0,20). The study of the serum CRP levels and WBC of patients say that CRP level in the two groups a peak on day 2, and in presence of AL, the CRP level not show a real decrease during the next few days. We observed high CRP levels in patients with pneumonia and other postoperative inflammations or sepsis. Conclusions: The serum CRP level is a relevant marker in diagnosis of the postoperative complications after colorectal resections. Cuvinte cheie: fistulă anastomotică, protiena C reactivă, pneumonie Rezumat: Fistula anastomotică (FA) este o complicație severă a chirurgiei colorectale, iar nivelul proteinei C reactive poate fi un marker predictiv al acestei complicații. Material și metodă: Studiul retrospectiv prezent analizează evoluția a 341 de pacienți cu cancere colorectale și anastomoze primare efectuate în intervalul 2003-2012 în Clinica Chirurgie I a Spitalului Clinic Județean de Urgenţă Sibiu. Rezultate: 7,3% din 341 de pacienți au dezvoltat FA, durata medie de apariție fiind 8,8 zile postoperator la toți pacienții cu FA. 20 (80%) din aceștia au fost reoperați, 20% dintre fistule au fost tratate conservator. Mortalitatea ridicată de 8% la pacienții cu FA s-a datorat sepsisului, în comparație cu 3,2% rată de mortalitate la pacienții fără FA şi sepsis (p=0,20). Determinarea nivelului seric al PCR și leucocitelor la pacienții operați a arătat un vârf de creștere a PCR în a 2-a zi la ambele grupe, iar în prezența FA, nu se observă o scădere reală a PCR-lui în intervalul următor. Am observat un nivel crescut al PCR la cei cu pneumonie și în prezența altor infecții postoperatorii sau inflamații. Concluzii: Nivelul seric al PCR este un marker relevant în diagnosticul complicațiilor postoperatorii din chirurgia colorectală. 1 Corresponding author: Mihai Sava, Bd. Corneliu Coposu, Nr. 2-4, Sibiu, România, E-mail: mihaisavasb@yahoo.com, Tel: +40745 263850. Article received on 15.07.2014 and accepted for publication on 29.08.2014 ACTA MEDICA TRANSILVANICA September 2014;2(3):275-279 INTRODUCTION In 1991, the United Kingdom Surgical Infection Study Group defined anastomotic leak as the “leak of luminal contents from a surgical join between two hollow viscera”.(1) Clinical anastomotic leakage is accompanied by signs of peritonitis or abscess, septicemia, and fecal or purulent discharge from the wound, drain or abscess.(1,2) The incidence of anastomotic leak following colorectal surgery varies among institutions and by anatomic location of anastomosis in colo- anal or colo-rectal anastomosis leak 1% to 19%, colo-colic leak 0% to 2%, ileo-colic leak 0,02% to 4% and ileo-ileal leak 1%.(3,4,5,6,7,8,9) Postoperative anastomotic leaks are one of the most devastating consequences of colorectal surgery. They occur in 2 to 51 percent of patients, and generally result in the need for emergent reoperation.(10-17) The anastomotic leaks occupy for approximately one-third of all deaths after colorectal surgery.(11,18,19) Because of the severity of the problems associated with an anastomotic leak, it is important and imperative in many cases to identify the complications and act it as early as possible. Extra-peritoneal anastomotic leaks, by definition, leak an innervated peritoneal surface and therefore may develop insidiously without peritoneal signs.(20,21,22) The first sign of this type of anastomotic leak may be unexplained cardiorespiratory or urinary symptoms during early postoperative period.(23,24,25,26). Even though the rate of anastomotic leaks in patients with anastomoses after resection for colon cancer in low, it remains a significant morbidity and mortality.(27,28,29,30) Identification of the best methods to discovered the presence of sepsis, it is justify, because, unfortunately, despite the progress in basic and clinical research efforts, mortality from septic shock remains unchanged or greater than 50%.(27-31) Anastomotic leakage apart from the early consequence, like postoperative morbidity, increased mortality, has been proven to have an independent negative impact on long – term survival after potentially curative resection of colorectal cancer.(32-39) Increased levels of C- reactive protein have already been established in acute pancreatitis and pancreas