CRP Monitoring After ICR in CD Patients
Condition: Crohn Disease; Ileocolic Resection
MeSH terms: Crohn Disease
Study type: Observational

Summary: 
      Aim: The aim of this study was to assess the accuracy of the C-reactive protein as an early
      predictor of intra-abdominal septic complicationss after ileocolic resection for Crohn
      disease.

      Methods: Data collected between January 2010 and March 2020 will be analyzed. Informations
      about preoperative, peroperative and post operative will be collected. The outcome after
      surgery will be analysed according to the comprehensive complication index.
    

Detailed description: 
      In colorectal surgery, inflammatory markers (CRP, PCT) are used systematically in the
      postoperative period as an early predictor of postoperative complications and in particular
      the prediction of anastomotic leaks and intra-abdominal septic complications.

      Indeed, the occurrence of an anastomotic leak (5 to 15% of cases) involves the introduction
      of antibiotics, the carrying out of invasive procedures which can go as far as reoperation
      (and the establishment of ostomy) and always increases the length of stay and the cost of
      hospitalization. It is therefore essential to benefit from the most sensitive and specific
      tools to detect this serious and sometimes lethal complication at an early stage.

      Numerous studies have evaluated and demonstrated the value of monitoring the CRP in the early
      postoperative period to detect the occurrence of an anastomotic leak. However, the majority
      of these studies presented heterogeneous populations for two reasons: all types of colorectal
      surgery interventions were included (right colectomy, transverse colectomy, left colectomy
      and anterior resection of the rectum) and multiple surgical indications were taken into
      account (colorectal cancer, inflammatory bowel disease, colonic diverticulosis).

      In addition, a 2015 study comparing the postoperative monitoring of markers of inflammation
      after ileocolic resection of patients with, on the one hand, Crohn's disease and, on the
      other, colon cancer showed a greater inflammatory reaction in patients with Crohn's disease
      (in particular on POD1, 4, 5 and 6) without identifying a threshold value. This increased
      inflammatory response can be explained by a greater inflammatory state than in the general
      population: bacterial translocation due to an alteration of the mucosal barrier aggravated by
      immunodeficiency.

      It thus appears that the cut-off values usually used (170-175 mg/l on POD3 and 125mg/l on
      POD4) are probably not suitable for the postoperative monitoring of these patients and for
      prediction of intra-abdominal septic complications.

      No study to date has identified a threshold value of postoperative CRP that can predict the
      occurrence of postoperative anastomotic fistula and intra-abdominal septic complications
      after ileocecal resection for Crohn's disease.
    

Intervention name(s): Laparoscopic or open Ileocolic resection
Intervention type(s): Procedure
Intervention description(s): Laparoscopic or open Ileocolic resection
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        Retrospective review of collected data including all consecutive patients requiring an
        ileocolic resection for Crohn disease between January 2010 and March 2020 at the Digestive
        Surgery Units of CHU Montpellier.
      
Keywords: Laparoscopy; C-reactive protein; Postoperative outcomes; Intra-abdominal septic complications