Revista do Colégio Brasileiro de Cirurgiões
https://revistadocbc.org.br/article/doi/10.1590/0100-6991e-20253798
Revista do Colégio Brasileiro de Cirurgiões
Artigo Original

O papel da proteína C-reativa na detecção de vazamento anastomótico colorretal e na alta precoce mais segura

C-reactive protein for detection of colorectal anastomotic leakage and safer early discharge

Tomas MDM Marques; Eliel M Rovaris; Rebeca H Nahime; Paulo Roberto Stevanato; Bruna EC Kupper; Andre L Bettiati; Tiago S Bezerra; Renata M Takahashi; Wilson T Nakagawa; Ademar Lopes; Samuel Aguiar

http://dx.doi.org/10.1590/0100-6991e-20253798 RCBC, vol.52, e20253798, 2025
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Resumo

Objetivo: A fístula de anastomose colorretal está associada a maior mortalidade, necessidade de reoperações, formação de estomas de derivação, alta hospitalar tardia e aumento de custos. A detecção precoce é fundamental para reduzir morbidade e melhorar os desfechos clínicos. Este estudo teve como objetivo avaliar o papel da proteína C-reativa (PCR) na detecção precoce de fístulas anastomóticas para otimizar o tratamento e acelerar a recuperação.

Métodos: Trata-se de um estudo observacional prospectivo que incluiu pacientes submetidos a colectomias no AC Camargo Cancer Center entre outubro de 2021 e dezembro de 2022. A PCR foi sistematicamente medida no 3º dia pós-operatório. O cuidado pós-operatório seguiu um protocolo institucional de recuperação precoce, incluindo alimentação e mobilização precoces, ausência de opioides e profilaxia antibiótica.

Resultados: Foram analisados 180 pacientes, dos quais 101 eram homens, com idade média de 62 anos. Dezoito pacientes (10%) apresentaram fístula anastomótica. A análise da curva ROC para PCR mostrou uma área sob a curva (AUC) de 0,860. O valor de corte de 11,2mg/dL apresentou sensibilidade de 77,8% e especificidade de 84,0%, com valor preditivo negativo (VPN) de 97,1%. Um valor de corte alternativo de 15,0mg/dL mostrou maior aplicabilidade clínica, com VPN de 96,1%. 

Conclusão: Valores de PCR abaixo de 15,0mg/dL no 3º dia pós-operatório foram eficazes para prever baixo risco de fístula anastomótica em pacientes assintomáticos, possibilitando alta hospitalar precoce e segura.

Palavras-chave

Fístula anastomótica; Cirurgia Colorretal; Proteína C-Reativa; Aprimoramento de recuperação cirúrgica

Abstract

Introduction: Colorectal anastomotic leakage is associated with increased mortality, need for reoperation, diverting stomas, delayed discharge and higher costs. Early detection of anastomotic leaks can significantly impact morbidity and clinical outcomes. The aim of this study is to identify the role of C-reactive protein (CRP) in the early detection of anastomotic leakage to improve treatment and fasten rehabilitation.

Methods: This is a prospective study that included 180 patients submitted to colectomies at AC Camargo Cancer Center from October 2021 to December 2022. C-reactive protein was systematically assessed on the third day after surgery. Postoperative care was provided by a single colorectal team based on our protocol for early recovery, which includes early feeding and mobilization, opioid avoidance and antibiotic prophylaxis.

Results: 180 patients were included in the study, comprising 79 women and 101 men, with a mean age of 62 years. Eighteen out of 180 patients presented with anastomotic leakage (10%). Analyzing the ROC curve for CRP, the area under the curve (AUC) was 0.860. The cutoff value was 11.2mg/dL, with an ROC of 0.81, resulting in a sensitivity of 77.8% and specificity of 84.0%. The negative predictive value (NPV) was 97.1%. An alternative cutoff with higher accuracy was 15.0mg/dL which has NPV of 96.1%, and more clinical applicability.

Conclusion: A postoperative CRP of less than 15.0mg/dL, measured on the 3rd postoperative day, was effective in predicting a low risk of anastomotic leakage on asymptomatic patients allowing safe early discharge.

Keywords

Anastomotic Leak; Colorectal Surgery; C-Reactive Protein; Enhanced Recovery After Surgery

Referências

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Submetido em:
22/07/2024

Aceito em:
17/08/2025

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