The edition · General Surgery
A day-2 CRP under 100 picks out colon resections at low risk of leak
Two multicentre cohorts move the CRP check a day earlier for ERAS discharge. Also: a pulse of methylprednisolone does not help digestive cancer surgery, incisional negative pressure dressings in 85 trials, and staging laparoscopy in gallbladder cancer.
The edition in brief
In two multicentre cohorts of elective colon cancer resections (401 and 213 patients), a C-reactive protein below 100 mg/L on postoperative day 2 carried a negative predictive value of about 99% for anastomotic leak needing intervention; leaks occurred in about 1% of those patients against about 8% of those with a higher CRP. Adding a falling CRP on day 3 for the rest let nearly 90% go home by day 2 or 3 with leak risk near 1%. A French double-blind trial of 1,210 patients found that 20 mg/kg methylprednisolone at induction did not reduce major complications after digestive cancer surgery (23% vs 20%), nor infections or length of stay. A meta-analysis of 85 randomised trials (16,980 patients) found incisional negative pressure wound therapy lowered surgical site infection (RR 0.64; number needed to treat 21) at the cost of more skin blistering and device problems, supporting selective use in high-risk wounds. In 330 patients with gallbladder cancer at a high-volume centre, staging laparoscopy found occult disease missed by imaging in 11.5%, most often para-aortic node metastases; an equivocal PET-CT and prior neoadjuvant chemotherapy predicted a positive laparoscopy.
High-dose methylprednisolone at induction did not reduce complications after digestive cancer surgery
A preoperative pulse of high-dose methylprednisolone did not reduce complications after digestive cancer surgery; do not use it routinely.
Incisional negative pressure dressings cut wound infection, with more blisters
Use incisional negative pressure dressings selectively on high-risk closed wounds, not routinely.
Staging laparoscopy found hidden disease in one in nine gallbladder cancers
Consider a staging laparoscopy before radical surgery for gallbladder cancer, especially after an equivocal PET-CT.
Tachycardia is often the first sign of an anastomotic leak
Investigate unexplained tachycardia after a bowel anastomosis as a possible leak.
A day-2 CRP below 100 mg/L makes a leak after colon resection unlikely
After elective colon resection, a day-2 CRP below 100 mg/L in a well patient supports early discharge.
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