Association Between Preoperative C-reactive Protein and Early Postoperative Complications in Patients With Colorectal Cancer: A Prospective Observational Study

BackgroundPostoperative complications are important adverse outcomes after colorectal cancer (CRC) surgery.Preoperative C-reactive protein (CRP), an accessible marker of systemic inflammation, may provide useful information about the risk of postoperative morbidity.This study aimed to evaluate the association between preoperative CRP and postoperative complications in patients undergoing elective CRC surgery and to assess its ability to discriminate complication severity. MethodsThis prospective observational study included 64 patients undergoing elective, potentially curative CRC surgery at the Department of Colorectal Surgery, Bangladesh Medical University, Dhaka, between March 2024 and February 2025.Preoperative CRP was measured, with concentrations >5 mg/L considered elevated.Postoperative complications occurring during hospitalization were recorded and graded according to the Clavien-Dindo classification.Associations between CRP and postoperative complications were assessed using the chi-square test or Fisher's exact test, as appropriate. ResultsAmong the 64 patients included, 42 (65.6%)were male patients.The mean age was 46.6 ± 15.3 years.Preoperative CRP was >5 mg/L in 24 (37.5%)patients.Overall, postoperative complications occurred in 43 (67.2%)patients, including wound infection in 17 (26.6%),anastomotic leakage in 6 (9.4%), respiratory complications in 6 (9.4%), and renal complications in 1 (1.6%).Patients with CRP >5 mg/L had significantly higher rates of wound infection (58.3% vs. 7.5%; P<0.001), respiratory complications (20.8% vs. 2.5%; P=0.024), and anastomotic leakage (25.0% vs. 0%; P=0.002) than those with CRP ≤5 mg/L.Among the 43 patients who developed postoperative complications, 10 (23.3%) had Clavien-Dindo grade ≥III complications.All patients with grade ≥III complications had CRP >5 mg/L, compared with 12 (36.4%)patients with grade I-II complications (P<0.001). ConclusionElevated preoperative CRP was associated with postoperative morbidity and greater complication severity in this cohort.Preoperative CRP may serve as an adjunct to perioperative risk assessment, although larger studies with independent validation are needed.