How to predict the complications after laparoscopic bowel resection in women with endometriosis

Serum C-reactive protein predicts postoperative complications following bowel resection for endometriosis

Key Points

Highlights:

• Serum CRP level higher than 56 mg/L on postoperative day 4, is an early sign of complications after bowel resection for endometriosis.

Importance:

• The postoperative complications in women who undergo bowel resection for endometriosis may be diagnose and prevented using serum CRP levels.

What’s done here?

• This retrospective cohort study was conducted on  66 women to clarify whether serum CRP values ​​can be used to detect postoperative complications in the early period.
• The patients who underwent bowel resection for stage 4 endometriosis were included with 16.8 months follow-up.
• Anastomotic leakages, infectious complications (except low urinary tract infections or common non-related respiratory infections) or thromboembolic complications, hematomas, bowel stenosis and fistulas, rectorrhagia, voiding dysfunction, and rehospitalization were the primary outcomes. 

Key results:

• The postoperative complication rate was 27.3% (18/66).
• Postoperative day 4 serum CRP has a sensitivity of 0.61 and a specificity of 0.98 at the cut-off value of 56 mg/L.
• In the patients who were re-hospitalized, the postoperative day 4 serum CRP was higher than 56 mg/L.
• Only one patient with a serum CRP level higher than 56 mg/L was without any complication, and 8 patients did have complications although serum CRP level was lower than 56 mg/L.

Strengths and Limitations

• This is a pilot study, but the small sample size and monocentric design is a limitation.
• However, the use of standardized diagnostic criteria for postoperative complications,  histopathological confirmation of endometriosis diagnosis and reproducible results were the strengths.

Lay Summary

The endometriotic lesions infiltrating the bowel wall more than 5 mm. are called "deep infiltrating endometriosis". The patients having bowel involvement may have constipation, diarrhea, tenesmus, or rectal bleeding. Surgical management is the main treatment modality to provide benefits on pain, infertility, and digestive symptoms.

There is still uncertainty about markers to be used for early diagnosis of complications that may be encountered during the postoperative period.

Pécheux et al. from France published a study titled “Predictive value of 4th post-operative-day CRP in the early detection of complications after laparoscopic bowel resection for endometriosis” in the "Journal of Gynecology Obstetrics and Human Reproduction".

The authors sought to investigate the usability of "day 4 postoperative serum CRP values" for the purpose of diagnosing postoperative complications in the early period. They also evaluated whether postoperative serum CRP value on day 4 would predict hospitalization duration.

The cut-off value was determined as 56 mg/L on postoperative day 4. Complications investigated were anastomotic leakages, infectious complications other than low urinary tract infections or common non-related respiratory infections,  thromboembolic complications, hematomas, bowel stenosis and fistulas, rectorrhagia, voiding dysfunction, and rehospitalization. The postoperative complication rate was found to be 27.3% (18/66). Postoperative day 4 serum CRP has a sensitivity of 0.61 and a specificity of 0.98 at the cut-off value of 56 mg/L. Postoperative day 4 serum CRP levels were higher than 56 mg/L in the re-hospitalized patients.

“Negative predictive value of CRP 56 mg/L on POD 4 after colorectal resection, in case of endometriosis, was really satisfying. Thus, this biomarker might be safely added as an additional criterion of a safe discharge from hospital.” the authors added.

Research Source: https://pubmed.ncbi.nlm.nih.gov/33872816/