Early Postoperative CRP as a Prognostic Marker in Robot-Assisted Rectal Cancer Surgery

Overview

This retrospective cohort study evaluated the prognostic value of C-reactive protein (CRP) measured on postoperative day 1 (POD1) for predicting complications after robot-assisted rectal cancer surgery (RARS). Elevated POD1 CRP levels were identified as an independent predictor of postoperative complications, supporting its utility as an early biomarker for risk stratification.

Background

Robot-assisted rectal surgery (RARS) offers enhanced dexterity and visualization for rectal cancer resections, with outcomes comparable or superior to laparoscopic and open techniques. Despite technological advances, postoperative complications remain a significant concern. Early identification of patients at risk is critical to improve outcomes. CRP, an acute-phase reactant, has been studied as a predictor of complications after colorectal surgery, but its specific role after RARS, particularly when measured early on POD1, requires further investigation.

Data Highlights

Key Findings

• Elevated CRP levels on postoperative day 1 were significantly associated with the occurrence of postoperative complications within 30 days.
• Multivariate logistic regression identified POD1 CRP as an independent predictor of overall postoperative complications after RARS.
• ROC curve analysis determined an optimal POD1 CRP cutoff value that maximized predictive accuracy for complications.
• Other factors analyzed included age, BMI, ASA score, neoadjuvant therapy, operative time, and stoma creation, but POD1 CRP remained a key prognostic marker.
• The study included 117 patients undergoing elective robot-assisted surgery for primary rectal cancer, with standardized perioperative care and CRP measurements.

Clinical Implications

Measuring CRP on postoperative day 1 provides clinicians with an early, objective biomarker to identify patients at increased risk of complications after robot-assisted rectal cancer surgery. This allows for timely interventions and closer monitoring, potentially improving patient outcomes. Incorporating POD1 CRP measurement into postoperative protocols may enhance risk stratification and guide clinical decision-making.

Conclusion

Early postoperative CRP measurement is a valuable prognostic tool for predicting complications following robot-assisted rectal cancer surgery. Its use can facilitate early identification of high-risk patients and improve postoperative management strategies.

References

1. Teraishi et al. 2025 -- C-reactive protein measured early as a prognostic indicator for postoperative complications after robot-assisted rectal cancer surgery