Beyond the Scalpel: Predicting Anastomotic Leakage After Colorectal Surgery Through Inflammatory Biomarkers

Davide Rinaldi¹, Oliver Bennett², Andreas Georgiou³

Abstract

 
Background: Anastomotic leakage remains one of the most serious complications after colorectal surgery. Early identification of high-risk patients may reduce morbidity and mortality.

Objective: To evaluate perioperative inflammatory biomarkers as predictors of anastomotic leakage.

Methods: A prospective cohort of 538 patients undergoing elective colorectal resection was followed between 2021 and 2024. Serum C-reactive protein (CRP), procalcitonin (PCT), and neutrophil–lymphocyte ratio (NLR) were measured postoperatively. Anastomotic leakage was confirmed radiologically or surgically.

Results: Leakage occurred in 47 patients (8.7%). Mean CRP on postoperative day 3 was 186 ± 42 mg/L in leakage patients versus 95 ± 33 mg/L in non-leakage patients (p < 0.001). PCT > 0.9 ng/mL predicted leakage with sensitivity 82% and specificity 79% (AUC 0.88). Combined CRP+PCT model achieved AUC 0.91. Prolonged operative time (>210 minutes) and BMI ≥ 30 increased risk (OR 2.1 and 1.8).

Conclusion: CRP and PCT on postoperative day 3 are strong early indicators of anastomotic leakage. Routine monitoring may guide preemptive imaging and early intervention.