A day-2 CRP below 100 may be enough to send colon resections home

The edition in brief

A Danish two-cohort diagnostic accuracy study in 614 elective colon cancer resections found that a C-reactive protein below 100 mg/L on postoperative day 2 carried a negative predictive value of about 99% for clinically significant anastomotic leak. For those above 100, a falling CRP on day 3 identified most of the remaining low-risk patients, so nearly 90% could be discharged by day 2 or 3 with leak risk near 1%. A French double-blind trial of 1,210 patients found 20 mg/kg methylprednisolone at induction did not reduce major complications after digestive cancer surgery (23% vs 20%). A meta-analysis of 85 randomised trials found incisional negative pressure wound therapy reduced surgical site infection (RR 0.64, NNT 21) but increased skin blistering (NNH 18) and device-related adverse events, supporting selective use. A network meta-analysis of 15 studies in malignant gastric outlet obstruction ranked EUS-guided gastroenterostomy highest for clinical success and durability, with stenting needing more reintervention, but drew partly on cohort data.