Evidence map›Paper›PMID 41408436›Full record

ArticleSurgical endoscopy2026

Diagnostic accuracy of C-reactive protein in detecting anastomotic leakage after minimally invasive rectal cancer surgery.

David J Nijssen, Mark Broekman, Franny Rensink, Gijs Stuart, Ritch T J Geitenbeek, Joost Stael, Susan van Dieren, Willem A Bemelman, Jurriaan Tuynman, Esther C J Consten and 3 more

Erratum issuedAbstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Surgical endoscopy, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors.

David J Nijssen *Department of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Mark Broekman *Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.ORCID 0000-0003-4497-9399
Franny RensinkDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Gijs StuartDepartment of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Ritch T J GeitenbeekDepartment of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Joost StaelDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Susan van DierenDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Willem A BemelmanDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Jurriaan TuynmanDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Esther C J ConstenDepartment of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Roel HompesDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands. r.hompes@amsterdamumc.nl.
Wytze LamérisDepartment of Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
Dutch MIRECA Collaborative Group

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundC-reactive protein's (CRP) diagnostic utility for early detection of anastomotic leakage is based on heterogeneous patient groups, including different pathologies and surgical approaches, without accounting for the presence of faecal diversion. This study assessed the diagnostic accuracy of CRP in detecting anastomotic leakage after minimally invasive total mesorectal excision (TME) for rectal cancer, stratified by the presence or absence of a primary diverting stoma.

methodsPatients from 11 high-volume centers in the Netherlands who underwent minimally invasive TME for rectal cancer between 2015 and 2021 were included. CRP levels were analyzed from postoperative days 1-4, and diagnostic accuracy was assessed using receiver operating characteristic analysis. Subgroup analyses were performed for patients with and without a primary diverting stoma.

resultsA total of 1418 patients were included, with anastomotic leakage occurring in 232 (16.4%). In patients without a stoma, the highest diagnostic accuracy was on day 4 at a cut-off of 104.5 mg/L, with sensitivity of 84.1%, specificity of 71.1%, PPV of 38.1%, and NPV of 95.5% (AUC = 0.83, P < 0.001). In patients with a stoma, diagnostic accuracy was lower, with maximum performance at a cut-off of 132.5 mg/L on day 4 (sensitivity 57.6%, specificity 78.7%, PPV 36.5%, NPV 89.7%, AUC = 0.71, P < 0.001). The difference in AUC was significant (P = 0.018).

conclusionCRP has poor diagnostic accuracy for detecting anastomotic leakage in patients with a primary diverting stoma after minimally invasive rectal cancer surgery. Additional diagnostic tests should be considered for this group to allow for early detection of anastomotic leaks.

Indexed as

Anastomotic LeakC-Reactive ProteinProctectomyRectal NeoplasmsAgedFemaleHumansMaleMiddle AgedMinimally Invasive Surgical ProceduresRetrospective StudiesSensitivity and SpecificityC-Reactive ProteinAnastomotic leakageC-reactive protein (CRP)Diagnostic accuracyMinimally invasive surgeryRectal cancerTotal mesorectal excision

Identifiers

PMID41408436

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.