226 The Role of CRP in Early Detection of Anastomotic Leak After Oesophagogastric Resections: A Single Centre Study

Abstract Aim Anastomotic leak remains a significant source of morbidity and mortality following oesophagogastric resections. Early detection is essential in this high-risk population. C-reactive protein (CRP) is a well-established marker of post-operative complications. This study aimed to assess the association between early post-operative CRP changes and anastomotic leaks, identifying a predictive threshold in our centre. Method All patients undergoing oesophagogastric resection from November 2023 to November 2024 were included. Changes in CRP (delta CRP) over the first 10 post-operative days (POD) were analysed. Univariate and multivariate analyses were conducted to identify significant predictors of anastomotic leak. A predictive model was developed to determine an optimal CRP threshold. Results A total of 156 patients were included; 112 were male, with a median age of 66 years and BMI of 27. Open procedures accounted for 69% of cases, and the anastomotic leak rate was 9.6%. The maximum delta CRP between POD1 and POD5 was significantly associated with leaks. A delta CRP >106 mg/L in this window yielded an AUC of 0.821 (sensitivity 1.00, specificity 0.55). Between POD1 and POD3, the same threshold gave an AUC of 0.77 (sensitivity 0.93, specificity 0.59). Conclusions In this single-centre study, a delta CRP >106 mg/L by POD3 serves as an early warning marker for anastomotic leak, with continued elevation by POD5 strongly predictive of leakage. CRP monitoring can guide earlier intervention and potentially improve outcomes following oesophagogastric surgery.