Early Postoperative Value of C-Reactive Protein: A Tool for Predicting or Excluding Complications After Elective Hepatectomy?

Abstract

Background: The predictive value of C-reactive protein (CRP) for anticipating or ruling out complications after elective abdominal surgery has been extensively studied. However, its role following elective liver resection (LR) remains poorly explored. This study aimed to evaluate the performance of CRP levels after LR.

Methods: The CRP values on postoperative day (POD) 1, 3 and 5 in a cohort of patients undergoing elective LR at a single tertiary center were retrospectively analyzed. Analyses were performed for laparoscopic and major LR subgroups.

Results: A total of 448 LR (392 patients), including 134 laparoscopic LR and 169 major LR, were analyzed. Severe morbidity (Clavien-Dindo grade ≥ III) occurred in 56 cases (12.4%) with an overall 90-day mortality rate of 2% (n = 9). Peak CRP levels were observed on POD 3. On POD 3, CRP levels were lower in the laparoscopic subgroup compared to open LR and lower after major LR compared to limited LR. In the overall cohort, the predictive CRP value on POD 1, 2, 3 remained poor for detecting major complications or any complications, with all calculated area under the curve (AUCs) below 0.65. Among the 69 patients with a POD 3 CRP value < 100 mg/L, only 2 developed major complications.

Conclusion: Unlike other abdominal procedures, CRP levels on POD 1, 3 and 5 after LR have insufficient predictive value for guiding postoperative management. The role of alternative biomarkers or early imaging strategies should be investigated.