Elevated drain fluid calprotectin as a predictor of early anastomotic leakage in colorectal surgery

Anastomotic leakage (AL) is a major cause of postoperative mortality following colorectal cancer surgery. This prospective investigation sought to establish the diagnostic utility of perioperative drain fluid calprotectin quantification in anticipating anastomotic complications following colorectal resections.

A consecutive cohort of 306 subjects undergoing anterior resection for sigmoid colon or rectal cancer were prospectively enrolled and stratified based on postoperative clinical outcomes: 25 cases developing AL (Group A) versus 281 without AL (Group B). Calprotectin levels in drainage fluid, serum C-reactive protein (CRP), and interleukin-6 (IL-6) were compared between the groups.

The diagnosis of AL was made between the 3rd and 11th postoperative day (POD), with a mean diagnosis time of 7 days. Group A showed significantly higher calprotectin levels starting from POD3 (207 vs. 96 ng/mL, p < 0.0001). POD3 calprotectin concentrations exceeding 110 ng/mL demonstrated superior discriminative capacity, achieving 92% diagnostic sensitivity with 82% specificity for preclinical AL detection.

Early and persistent elevation of drain fluid calprotectin after colorectal surgery is a significant marker for AL, potentially offering an advantage over traditional inflammatory markers like CRP and IL-6 in the earlier prediction of AL. These findings provide valuable insights for improving postoperative management and patient outcomes.