Is postoperative measured CRP a reliable marker of anastomotic leakage following radical cystectomy and urinary diversion?
Kertész László Róbert dr., Kovács Lukács dr., Vrecenár László dr., Mózes Tibor dr., Buzogány István dr., Beöthe Tamás dr.
Péterfy Sándor Utcai Kórház, Urológia Osztály, Budapest (osztályvezető: Buzogány István dr.)
Introduction: The standard therapy for patients with muscle-invasive bladder cancer is radical cystectomy with extended lymphadenectomy and urinary diversion. As alternative procedure organ-preserving surgical procedures have been established to radical surgery. Trimodal therapy consisting of maximal TURB, radiation therapy, chemotherapy, an effective treatment for selected patients with muscle-invasive bladder cancer that allows for preservation of the urinary bladder.
Aims: The main objective of this study was to help predict the risk of small intestinal anastomotic insufficiency following cystectomies with ileal conduit urinary diversion or orthotopic neobladder formation by monitoring serum CRP, WBC levels.
Methods: In checked period 254 radical cystectomies was done on urology department of Peterfy Hospital. 51 patients from these patients were enrolled in this study. Serum IL-6, TNFa, Soluble TNFa receptor I. were measured from sera, by ELISA and HS ELISA kits. Serum CRP and WBC counts identified by standard laboratory methods. Statistical analysis was performed by IBM SPSS statistics 23.
Results: From the enrolled patients five patients were diagnosed with small intestinal anastomotic leakage (AL) The developed infections’ median time were on the postoperative 15th day. (POD15). The notable elevation of the serum CRP on the second postoperative week could predict the anastomotic leakage. When comparing the AL and nonseptic subgroups statistically significant differences were found on WBC counts on day 6, 9 and 14. Between the septic and AL groups, a significant difference was found in WBC counts on day 6 and 9. The hospitalization period was significantly longer in the anastomotic leakage group than in the other 44 patients.
Conclusion: Monitoring the changes of CRP is a helpful predictor of small intestinal anastomotic insufficiency following cystectomies with ileal conduit urinary diversion or orthotopic neobladder. Based on studies of colorectal surgeries complications, and our study the elevated serum CRP could be a marker of postoperative septic complications, moreover of anastomosis insufficiency.