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Sánchez‐Iglesias JL, Morales‐Coma C, Minig L, Lago V, Domingo S, Mancebo G, Siegrist J, Fidalgo García MS, Llueca A, Serra A, Cobas Lozano P, Lekuona Artola A, Gómez‐Hidalgo NR, Acosta Ú, Ferrer‐Costa R, Bradbury M, Pérez‐Benavente A, Gil‐Moreno A. Procalcitonin and C-reactive protein as early markers of anastomotic leakage in intestinal resections for advanced ovarian cancer (EDMOCS). Acta Obstet Gynecol Scand 2024; 103:1302-1310. [PMID: 38532280 PMCID: PMC11168259 DOI: 10.1111/aogs.14834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/28/2024]
Abstract
INTRODUCTION Serum levels of procalcitonin and C-reactive protein (CRP) have been used to predict anastomotic leakage after colorectal surgery, but information is scarce in advanced ovarian cancer (AOC) surgery with bowel resection. This study aimed to assess the predictive value of procalcitonin and CRP in detecting anastomotic leakage after AOC surgery with bowel resection. The study also aimed to determine the optimal postoperative reference values and the best day for evaluating these markers. MATERIAL AND METHODS This prospective, observational and multicentric trial included 92 patients with AOC undergoing debulking surgery with bowel resection between 2017 and 2020 in 10 reference hospitals in Spain. Procalcitonin and CRP levels were measured at baseline and on postoperative days 1-6. Receiver operating characteristic analysis was performed to evaluate the predictive value of procalcitonin and CRP at each postoperative day. Sensitivity, specificity, positive and negative predictive values were calculated. RESULTS Anastomotic leakage was detected in six patients (6.5%). Procalcitonin and CRP values were consistently higher in patients with anastomotic leakage at all postoperative days. The maximum area under the curve (AUC) for procalcitonin was observed at postoperative day 1 (AUC = 0.823) with a cutoff value of 3.8 ng/mL (83.3% sensitivity, 81.3% specificity). For CRP, the maximum AUC was found at postoperative day 3 (AUC = 0.833) with a cutoff level of 30.5 mg/dL (100% sensitivity, 80.4% specificity). CONCLUSIONS Procalcitonin and C-reactive protein are potential biomarkers for early detection of anastomotic leakage after ovarian cancer surgery with bowel resection. Further prospective studies with a larger sample size are needed to confirm these findings.
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Affiliation(s)
- José Luis Sánchez‐Iglesias
- Department of Gynecologic OncologyVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | | | - Lucas Minig
- Department of Gynecologic OncologyIMED HospitalValenciaSpain
- Department of GynecologyCEU Cardenal Herrera UniversityValenciaSpain
| | - Víctor Lago
- Department of GynecologyCEU Cardenal Herrera UniversityValenciaSpain
- Department of Gynecologic OncologyLa Fe University HospitalValenciaSpain
| | - Santiago Domingo
- Department of Gynecologic OncologyLa Fe University HospitalValenciaSpain
| | - Gemma Mancebo
- Gynecological Cancer Multidisciplinary UnitHospital del MarBarcelonaSpain
- Department of GynecologyUniversitat Pompeu FabraBarcelonaSpain
| | - Jaime Siegrist
- Oncologic Gynecology Unit, Department of GynecologyLa Paz University HospitalMadridSpain
| | | | - Antoni Llueca
- Multidisciplinary Unit of Abdominal Pelvic Oncology SurgeryHospital General Universitario de CastellonCastellónSpain
- Department of MedicineUniversidad Jaume ICastellónSpain
| | - Anna Serra
- Multidisciplinary Unit of Abdominal Pelvic Oncology SurgeryHospital General Universitario de CastellonCastellónSpain
- Department of MedicineUniversidad Jaume ICastellónSpain
| | - Paloma Cobas Lozano
- Department of Gynecologic OncologyHospital Universitario Donostia, OSI DonostialdeDonostiaSpain
| | - Arantza Lekuona Artola
- Department of Gynecologic OncologyHospital Universitario Donostia, OSI DonostialdeDonostiaSpain
| | | | - Úrsula Acosta
- Department of Gynecologic OncologyVall d'Hebron University HospitalBarcelonaSpain
| | - Roser Ferrer‐Costa
- Department of BiochemistryVall d'Hebron University HospitalBarcelonaSpain
| | - Melissa Bradbury
- Department of Gynecologic OncologyVall d'Hebron University HospitalBarcelonaSpain
| | - Assumpció Pérez‐Benavente
- Department of Gynecologic OncologyVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
| | - Antonio Gil‐Moreno
- Department of Gynecologic OncologyVall d'Hebron University HospitalBarcelonaSpain
- Biomedical Research Group in Gynecology, Vall d'Hebron Research Institute (VHIR)Universitat Autònoma de BarcelonaBarcelonaSpain
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Huang Y, Li TY, Weng JF, Liu H, Xu YJ, Zhang S, Gu WL. Peritoneal fluid indocyanine green test for diagnosis of gut leakage in anastomotic leakage rats and colorectal surgery patients. World J Gastrointest Surg 2024; 16:1825-1834. [PMID: 38983318 PMCID: PMC11230036 DOI: 10.4240/wjgs.v16.i6.1825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/22/2024] [Accepted: 05/06/2024] [Indexed: 06/27/2024] Open
Abstract
BACKGROUND Application of indocyanine green (ICG) fluorescence has led to new developments in gastrointestinal surgery. However, little is known about the use of ICG for the diagnosis of postoperative gut leakage (GL). In addition, there is a lack of rapid and intuitive methods to definitively diagnose postoperative GL. AIM To investigate the effect of ICG in the diagnosis of anastomotic leakage in a surgical rat GL model and evaluate its diagnostic value in colorectal surgery patients. METHODS Sixteen rats were divided into two groups: GL group (n = 8) and sham group (n = 8). Approximately 0.5 mL of ICG (2.5 mg/mL) was intravenously injected postoperatively. The peritoneal fluid was collected for the fluorescence test at 24 and 48 h. Six patients with rectal cancer who had undergone laparoscopic rectal cancer resection plus enterostomies were injected with 10 mL of ICG (2.5 mg/mL) on postoperative day 1. Their ostomy fluids were collected 24 h after ICG injection to identify the possibility of the ICG excreting from the peripheral veins to the enterostomy stoma. Participants who had undergone colectomy or rectal cancer resection were enrolled in the diagnostic test. The peritoneal fluids from drainage were collected 24 h after ICG injection. The ICG fluorescence test was conducted using OptoMedic endoscopy along with a near-infrared fluorescent imaging system. RESULTS The peritoneal fluids from the GL group showed ICG-dependent green fluorescence in contrast to the sham group. Six samples of ostomy fluids showed green fluorescence, indicating the possibility of ICG excreting from the peripheral veins to the enterostomy stoma in patients. The peritoneal fluid ICG test exhibited a sensitivity of 100% and a specificity of 83.3% for the diagnosis of GL. The positive predictive value was 71.4%, while the negative predictive value was 100%. The likelihood ratios were 6.0 for a positive test result and 0 for a negative result. CONCLUSION The postoperative ICG test in a drainage tube is a valuable and simple technique for the diagnosis of GL. Hence, it should be employed in clinical settings in patients with suspected GL.
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Affiliation(s)
- Yu Huang
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Tian-Yang Li
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Jie-Feng Weng
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Hui Liu
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Yu-Jie Xu
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Shuai Zhang
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
| | - Wei-Li Gu
- Department of Surgery, Guangzhou First People's Hospital, Guangzhou 510180, Guangdong Province, China
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de Wit A, Daams F. Considerations in case of suspected anastomotic leakage in the lower GI tract. Best Pract Res Clin Gastroenterol 2024; 70:101925. [PMID: 39053975 DOI: 10.1016/j.bpg.2024.101925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/12/2024] [Accepted: 06/04/2024] [Indexed: 07/27/2024]
Abstract
Colorectal anastomotic leakage (CAL) remains a feared complication after colorectal surgery and requires prompt detection and proper treatment. With the upswing of fast-track recovery programs in recent years this challenge has increased, as clinical features may only arise after discharge. Therefore, identification of the best diagnostic tools is of utmost importance, also since early treatment is associated with high success rates. Diagnostic tools range from general screening tools to invasive procedures to assess the severity of the leak. Laboratory tests, in particular the inflammation biomarkers C-reactive protein and procalcitonin, have a significant role in the detection of CAL after colorectal surgery. As these biomarkers are unspecific for CAL, additional imaging should be performed when blood levels are elevated. The golden standard for the detection of AL after colonic resections is a computed tomography (CT-scan). If tolerated, a contrast medium should be administered rectally to enhance diagnostic accuracy. When suspicion of CAL remains high despite negative previous tests, further endoscopy examination should be conducted. However, endoscopic examinations become more suitable for the early diagnostic work-up after rectal resections. This review aims to provide an overview of current diagnostics for the screening and assessment of the severity of CAL after colorectal surgery.
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Affiliation(s)
- A de Wit
- Amsterdam University Medical Centers, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands.
| | - F Daams
- Amsterdam University Medical Centers, Department of Surgery, Amsterdam, the Netherlands; Cancer Center Amsterdam, Amsterdam, the Netherlands
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McKechnie T, Cloutier Z, Archer V, Park L, Lee J, Heimann L, Patel A, Hong D, Eskicioglu C. Using preoperative C-reactive protein levels to predict anastomotic leaks and other complications after elective colorectal surgery: A systematic review and meta-analysis. Colorectal Dis 2024; 26:1114-1130. [PMID: 38720514 DOI: 10.1111/codi.17017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 02/10/2024] [Accepted: 04/01/2024] [Indexed: 06/28/2024]
Abstract
AIM While postoperative C-reactive protein (CRP) is used routinely as an early indicator of anastomotic leak (AL), preoperative CRP remains to be established as a potential predictor of AL for elective colorectal surgery. The aim of this systematic review and meta-analysis is to examine the association between preoperative CRP and postoperative complications including AL. METHOD MEDLINE, EMBASE, Web of Science, PubMed, Cochrane Library and CINAHL databases were searched. Studies with reported preoperative CRP values and short-term surgical outcomes after elective colorectal surgery were included. An inverse variance random effects meta-analysis was performed for all meta-analysed outcomes to determine if patients with or without complications and AL differed in their preoperative CRP levels. Risk of bias was assessed with MINORS and certainty of evidence with GRADE. RESULTS From 1945 citations, 23 studies evaluating 7147 patients were included. Patients experiencing postoperative infective complications had significantly greater preoperative CRP values [eight studies, n = 2421 patients, mean difference (MD) 8.0, 95% CI 3.77-12.23, p < 0.01]. A significant interaction was observed with subgroup analysis based on whether patients were undergoing surgery for inflammatory bowel disease (X2 = 8.99, p < 0.01). Preoperative CRP values were not significantly different between patients experiencing and not experiencing AL (seven studies, n = 3317, MD 2.15, 95% CI -2.35 to 6.66, p = 0.35), nor were they different between patients experiencing and not experiencing overall postoperative morbidity (nine studies, n = 2958, MD 4.54, 95% CI -2.55 to 11.62, p = 0.31) after elective colorectal surgery. CONCLUSION Higher preoperative CRP levels are associated with increased rates of overall infective complications, but not with AL alone or with overall morbidity in patients undergoing elective colorectal surgery.
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Affiliation(s)
- Tyler McKechnie
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Zacharie Cloutier
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Vicki Archer
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lily Park
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Jay Lee
- Division of General Surgery, Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | | | - Ashaka Patel
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Dennis Hong
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St Joseph Healthcare, Hamilton, Ontario, Canada
| | - Cagla Eskicioglu
- Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
- Division of General Surgery, Department of Surgery, St Joseph Healthcare, Hamilton, Ontario, Canada
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Agnello L, Buscemi S, Di Buono G, Vidali M, Lo Sasso B, Agrusa A, Ciaccio M. Drainage fluid LDH and neutrophil to lymphocyte ratio as biomarkers for early detecting anastomotic leakage in patients undergoing colorectal surgery. Clin Chem Lab Med 2024; 62:967-978. [PMID: 37988156 DOI: 10.1515/cclm-2023-1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES In this study, we investigated the role of several circulating and drainage fluid biomarkers for detecting postoperative complications (PCs) and anastomotic leakage (AL) in patients undergoing colorectal surgery. METHODS All consecutive patients undergoing colorectal surgery between June 2018 and April 2020 were prospectively considered. On postoperative days (POD) 1, 3, and 5, we measured lactate dehydrogenase (LDH) in drainage fluid, C-reactive protein (CRP) in serum and drainage fluid, and neutrophil to lymphocyte ratio (NLR). RESULTS We enrolled 187 patients. POD1 patients with AL had higher serum CRP levels, while on POD3 and on POD5 higher NLR and serum CRP. LDH and CRP in drainage fluid were also significantly higher at both time points. The area under the curves (AUCs) of serum and drainage fluid CRP were 0.752 (0.629-0.875) and 0.752 (0.565-0.939), respectively. The best cut-off for serum and drainage fluid CRP was 185.23 and 76 mg/dL, respectively. The AUC of NLR on POD3 was 0.762 (0.662-0.882) with a sensitivity and specificity of 84 and 63 %, respectively, at a cut-off of 6,6. Finally, drainage fluid LDH showed the best diagnostic performance for AL, with an AUC, sensitivity, and specificity of 0.921 (0.849-0.993), 82 %, and 90 % at a cut-off of 2,186 U/L. Trends in serum parameters between patients with or without PCs or AL were also evaluated. Interestingly, we found that NLR decreased faster in patients without PCs than in patients with PCs and patients with AL. CONCLUSIONS Drainage fluid LDH and NLR could be promising biomarkers of PCs and AL.
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Affiliation(s)
- Luisa Agnello
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
| | - Salvatore Buscemi
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Giuseppe Di Buono
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Matteo Vidali
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
| | - Bruna Lo Sasso
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
- Department of Laboratory Medicine, AOUP "P. Giaccone", Palermo, Italy
| | - Antonino Agrusa
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, Palermo, Italy
| | - Marcello Ciaccio
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, Institute of Clinical Biochemistry, Clinical Molecular Medicine and Clinical Laboratory Medicine, University of Palermo, Palermo, Italy
- Department of Laboratory Medicine, AOUP "P. Giaccone", Palermo, Italy
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Hendriks S, Huisman MG, Stokmans SC, Plas M, van der Wal-Huisman H, van Munster BC, Absalom AR, Nieuwenhuijs-Moeke GJ, de Bock GH, van Leeuwen BL, de Haan JJ. The Association Between Intraoperative Compromised Intestinal Integrity and Postoperative Complications in Cancer Patients. Ann Surg Oncol 2024; 31:2699-2708. [PMID: 38225477 PMCID: PMC10908644 DOI: 10.1245/s10434-023-14857-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 12/17/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Because of perioperative splanchnic hypoperfusion, the gut wall becomes more permeable for intraluminal microbes to enter the splanchnic circulation, possibly contributing to development of complications. Hypoperfusion-related injured enterocytes release intestinal fatty acid binding protein (I-FABP) into plasma, which is used as proxy of intestinal integrity. This study investigates the occurrence of intestinal integrity loss during oncologic surgery, measured by I-FABP change. Secondary the relationship between compromised intestinal integrity, and related variables and complications were studied. METHODS Patients undergoing oncologic surgery from prospective cohort studies were included. Urine I-FABP samples were collected preoperatively (T0) and at wound closure (T1), and in a subgroup on Day 1 (D1) and Day 2 (D2) postoperatively. I-FABP dynamics were investigated and logistic regression analyses were performed to study the association between I-FABP levels and patient-related, surgical variables and complications. RESULTS A total of 297 patients were included with median age of 70 years. Median I-FABP value increased from 80.0 pg/mL at T0 (interquartile range [IQR] 38.0-142.0) to 115 pg/mL at T1 (IQR 48.0-198.0) (p < 0.05). Age (odds ratio [OR] 1.05, 95% confidence interval [CI] 1.02-1.08) and anesthesia time (OR 1.13, 95% CI 1.02-1.25) were related to stronger I-FABP increase. When comparing I-FABP change in patients experiencing any complications versus no complications, relative I-FABP change at T1 was 145% of T0 (IQR 86-260) versus 113% (IQR 44-184) respectively (p < 0.05). CONCLUSIONS A significant change in I-FABP levels was seen perioperatively indicating compromised intestinal integrity. Age and anesthesia time were related to higher I-FABP increase. In patients experiencing postoperative complications, a higher I-FABP increase was found.
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Affiliation(s)
- Sharon Hendriks
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Monique G Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Suzanne C Stokmans
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Matthijs Plas
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke van der Wal-Huisman
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara C van Munster
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Anthony R Absalom
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gertrude J Nieuwenhuijs-Moeke
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Barbara L van Leeuwen
- Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jacco J de Haan
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Liu J, Liu N, Xu Y, Wu M, Zhang H, Wang Y, Yan Y, Hill A, Song R, Xu Z, Park M, Wu Y, Ciatti JL, Gu J, Luan H, Zhang Y, Yang T, Ahn HY, Li S, Ray WZ, Franz CK, MacEwan MR, Huang Y, Hammill CW, Wang H, Rogers JA. Bioresorbable shape-adaptive structures for ultrasonic monitoring of deep-tissue homeostasis. Science 2024; 383:1096-1103. [PMID: 38452063 DOI: 10.1126/science.adk9880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024]
Abstract
Monitoring homeostasis is an essential aspect of obtaining pathophysiological insights for treating patients. Accurate, timely assessments of homeostatic dysregulation in deep tissues typically require expensive imaging techniques or invasive biopsies. We introduce a bioresorbable shape-adaptive materials structure that enables real-time monitoring of deep-tissue homeostasis using conventional ultrasound instruments. Collections of small bioresorbable metal disks distributed within thin, pH-responsive hydrogels, deployed by surgical implantation or syringe injection, allow ultrasound-based measurements of spatiotemporal changes in pH for early assessments of anastomotic leaks after gastrointestinal surgeries, and their bioresorption after a recovery period eliminates the need for surgical extraction. Demonstrations in small and large animal models illustrate capabilities in monitoring leakage from the small intestine, the stomach, and the pancreas.
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Affiliation(s)
- Jiaqi Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Naijia Liu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Yameng Xu
- The Institute of Materials Science and Engineering, Washington University in St. Louis, St. Louis, MO 63130, USA
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mingzheng Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Haohui Zhang
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Yue Wang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Ying Yan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Angela Hill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Ruihao Song
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Chemical and Biological Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Zijie Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Minsu Park
- Department of Polymer Science and Engineering, Dankook University, Yongin 16890, Republic of Korea
| | - Yunyun Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Joanna L Ciatti
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jianyu Gu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Haiwen Luan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Yamin Zhang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Tianyu Yang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Hak-Young Ahn
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Shupeng Li
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Wilson Z Ray
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Colin K Franz
- Regenerative Neurorehabilitation Laboratory, Shirley Ryan AbilityLab, Chicago, IL 60611, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- The Ken and Ruth Davee Department of Neurology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Matthew R MacEwan
- Department of Neurosurgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yonggang Huang
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Chet W Hammill
- Department of Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Heling Wang
- Laboratory of Flexible Electronics Technology, Tsinghua University, Beijing 100084, China
- Institute of Flexible Electronics Technology of THU Zhejiang, Jiaxing 314000, China
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Liu Y, Zhou J, Gu Y, Hu W, Lin H, Shang Q, Zhang H, Yang Y, Yuan Y, Chen L. Will synchronous esophageal and lung resection increase the incidence of anastomotic leaks? A multicenter retrospective study. Int J Surg 2024; 110:1653-1662. [PMID: 38181122 PMCID: PMC10942245 DOI: 10.1097/js9.0000000000001018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2024] [Accepted: 12/11/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND Reports on combined resection for synchronous lung lesions and esophageal cancer (CRLE) cases are rare and mostly individual cases. Furthermore, the feasibility of CRLE has always been a controversial topic. In the current study, the authors retrospectively analyzed the feasibility of CRLE and established an individualized prediction model for esophageal anastomotic leaks after CRLE by performing a multicenter retrospective study. METHODS Patients who underwent esophagectomy between January 2009 and June 2021 were extracted from a four-center prospectively maintained database, and those with CRLE at the same setting were matched in a 1:2 propensity score-matched (PSM) ratio to esophagectomy alone (EA) patients. A nomogram was then established based on the variables involved in multivariate logistic regression analysis. Internal validation of the nomogram was conducted utilizing Bootstrap resampling. Decision and clinical impact curve analysis were computed to assess the practical clinical utility of the nomogram. A prognosis analysis for CRLE and EA patients by Kaplan-Meier curves was conducted. RESULTS Of the 7152 esophagectomies, 216 cases of CRLE were eligible, and 1:2 ratio propensity score-matched EA patients were matched. The incidence of anastomotic leaks following CRLE increased significantly ( P =0.035). The results of the multivariate analysis indicated the leaks varied according to the type of lung resection (anatomic>wedge resection, P =0.016) and site of resected lobe (upper>middle/low lobe; P =0.027), and a nomogram was established to predict the occurrence of leaks accurately (area under the curve=0.786). Although no statistically significant difference in overall survival (OS) was observed in the CRLE group ( P =0.070), a trend toward lower survival rates was noted. Further analysis revealed that combined upper lobe anatomic resection was significantly associated with reduced OS ( P =0.027). CONCLUSION Our study confirms that CRLE is feasible but comes with a significantly increased risk of anastomotic leaks and a concerning trend of reduced survival, particularly when upper lobe anatomic resections are performed. These findings highlight the need for careful patient selection and surgical planning when considering CRLE.
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Affiliation(s)
- Yixin Liu
- Department of Thoracic Surgery, West China Hospital of Sichuan University
| | - Jianfeng Zhou
- Department of Thoracic Surgery, West China Hospital of Sichuan University
| | - Yimin Gu
- Department of Thoracic Surgery, West China Hospital of Sichuan University
- Department of Thoracic Surgery, Shangjin Nanfu hospital of Chengdu
| | - Weipeng Hu
- Department of Thoracic Surgery, West China Hospital of Sichuan University
- Department of Thoracic Surgery, Sanya People’s Hospital
| | - Haonan Lin
- Department of Thoracic Surgery, West China Hospital of Sichuan University
- Department of Thoracic Surgery, West China Tianfu Hospital, Sichuan, People’s Republic of China
| | - Qixin Shang
- Department of Thoracic Surgery, West China Hospital of Sichuan University
| | - Hanlu Zhang
- Department of Thoracic Surgery, West China Hospital of Sichuan University
| | - Yushang Yang
- Department of Thoracic Surgery, West China Hospital of Sichuan University
| | - Yong Yuan
- Department of Thoracic Surgery, West China Hospital of Sichuan University
| | - Longqi Chen
- Department of Thoracic Surgery, West China Hospital of Sichuan University
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9
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Procházka V, Lacina L, Smetana K, Svoboda M, Skřivanová K, Beňovská M, Jarkovský J, Křen L, Kala Z. Serum concentrations of proinflammatory biomarker interleukin-6 (IL-6) as a predictor of postoperative complications after elective colorectal surgery. World J Surg Oncol 2023; 21:384. [PMID: 38098074 PMCID: PMC10720211 DOI: 10.1186/s12957-023-03270-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The aim of this prospective study was to evaluate the role of serum IL-6 as a potential predictive biomarker of postoperative complications (POC) in elective colorectal surgery. METHOD A total of 115 patients underwent colorectal surgery for malignancy. IL-6 was measured on the first and third postoperative days (POD1, POD3), and C-reactive protein (CRP) was measured on the POD3. POC was analysed in subgroups according to Clavien‒Dindo (CD), antibiotic (ATB) treatment, intensive care unit (ICU) and hospital length of stay. The predictive power of variables for evaluated endpoints was analysed using receiver-operating characteristic (ROC) analysis and described by area under the curve (AUC). ROC analysis was adopted for the identification of optimal cut-offs. Histological analysis was performed to verify IL-6 production by the tumour. RESULTS Out of 115 patients who were analysed, 42% had POC. Patients with POC had significantly higher serum levels of IL-6 on POD1 (p < 0.001) and POD3 (p < 0.001). IL-6 early on POD1 as a predictor of antibiotic treatment, ICU stay and hospital stay (AUC 0.818; 0.811; 0.771) did not significantly differ from the AUC of CRP late on POD3 (0.879; 0.838, 0.752). A cut-off IL-6 value of 113 pg/ml on POD1 and 180.5 pg/ml on POD3 in severe complications (CD > 3a) resulted in 75% and 72% sensitivity, 78.6% and 99% specificity, negative predictive value 96.4% and 97% and positive predictive value 29% and 88.9%. CONCLUSION The serum level of interleukin-6 can predict severe (CD > 3a) POC early on POD1. On POD3, IL-6 is superior to CRP in terms of high positive predictive power of severe POC. Interestingly, the advantage of IL-6 on POD1 is early prediction of the need for antibiotic treatment, ICU stay and hospital stay, which is comparable to the CRP serum level late on the third POD.
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Grants
- Conceptual development of research organisation, FNBr, 65269705 Ministerstvo Zdravotnictví Ceské Republiky,Czechia
- Conceptual development of research organisation, FNBr, 65269705 Ministerstvo Zdravotnictví Ceské Republiky,Czechia
- Conceptual development of research organisation, FNBr, 65269705 Ministerstvo Zdravotnictví Ceské Republiky,Czechia
- Conceptual development of research organisation, FNBr, 65269705 Ministerstvo Zdravotnictví Ceské Republiky,Czechia
- Conceptual development of research organisation, FNBr, 65269705 Ministerstvo Zdravotnictví Ceské Republiky,Czechia
- project National Institute for Cancer Research (Programme EXCELES, ID Project No. LX22NPO5102) Operational Programme Research, Development, and Education
- project National Institute for Cancer Research (Programme EXCELES, ID Project No. LX22NPO5102) Operational Programme Research, Development, and Education
- Cooperatio ONCO Univerzita Karlova v Praze
- Cooperatio ONCO Univerzita Karlova v Praze
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Affiliation(s)
- Vladimír Procházka
- Department of Surgery, Faculty of Medicine, University Hospital Brno Bohunice, Masaryk University, Brno, Czech Republic
| | - Lukáš Lacina
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Dermatovernereology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Karel Smetana
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Martin Svoboda
- Department of Surgery, Faculty of Medicine, University Hospital Brno Bohunice, Masaryk University, Brno, Czech Republic.
| | - Kateřina Skřivanová
- Department of Clinical Psychology, University Hospital Brno-Bohunice, Brno, Czech Republic
| | - Miroslava Beňovská
- Division of Clinical Biochemistry, Department of Laboratory Medicine, University Hospital Brno, Brno, Czech Republic
- Department of Laboratory Methods, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jiří Jarkovský
- Faculty of Medicine, Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Leoš Křen
- Department of Pathology, Faculty of Medicine, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Zdeněk Kala
- Department of Surgery, Faculty of Medicine, University Hospital Brno Bohunice, Masaryk University, Brno, Czech Republic
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10
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Choi JDW, Kwik C, Shanmugalingam A, Allan L, Khoury TE, Pathmanathan N, Toh JWT. C-Reactive Protein as a Predictive Marker for Anastomotic Leak Following Restorative Colorectal Surgery in an Enhanced Recovery After Surgery Program. J Gastrointest Surg 2023; 27:2604-2607. [PMID: 37556035 PMCID: PMC10660981 DOI: 10.1007/s11605-023-05798-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/29/2023] [Indexed: 08/10/2023]
Affiliation(s)
- Joseph Do Woong Choi
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Charlotte Kwik
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia
| | - Aswin Shanmugalingam
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia
| | - Lachlan Allan
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia
| | - Toufic El Khoury
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine, University of Notre Dame, Sydney, NSW, Australia
| | - Nimalan Pathmanathan
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James Wei Tatt Toh
- Department of Colorectal Surgery, Westmead Hospital. Corner Hawkesbury Road and Darcy Roads, Westmead, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
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11
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Gielen AHC, Melenhorst J, Breukink SO, Weijenberg MP, Bours MJL. The Relation of Lifestyle with Inflammation at the Time of Diagnosis in Patients with Colorectal Cancer. Cancers (Basel) 2023; 15:4307. [PMID: 37686583 PMCID: PMC10486596 DOI: 10.3390/cancers15174307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 09/10/2023] Open
Abstract
Colorectal cancer is one of the most common lifestyle-related types of cancer. The exact pathophysiologic mechanism in the relation between (visceral) adipose tissue, systemic inflammation and colorectal cancer remains unknown. This study aimed to assess the association of lifestyle with markers of systemic inflammation at the time of diagnosis in stage I-III colorectal cancer patients. Patients (n = 298) with stage I-III colorectal cancer from three Dutch hospitals were included at diagnosis. Several lifestyle-related variables (MUST nutritional status score, WCRF/AICR healthy lifestyle score, active smoking, alcohol consumption and BMI) and inflammatory markers (plasma levels of IL-6, IL-8, IL-10, TNFα and 'high sensitive' hsCRP) were measured at the time of diagnosis. Confounder-adjusted multivariable linear regression models were used to analyse how the lifestyle variables were associated with the inflammatory markers. Statistically significant associations were found between a better WCRF/AICR lifestyle score and lower levels of IL-6 and hsCRP. A medium and high risk of malnutrition according to the MUST score was associated with elevated levels of both IL-8 and hsCRP. An overall unhealthier lifestyle indicated by a lower WCRF/AICR lifestyle score and a higher risk of malnutrition according to the MUST score at the time of diagnosis was associated with elevated levels of inflammatory markers. These findings can contribute to formulating lifestyle advice to improve treatment outcomes and prognosis in patients having CRC in the future.
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Affiliation(s)
- Anke H. C. Gielen
- Department of Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Jarno Melenhorst
- Department of Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
| | - Stephanie O. Breukink
- Department of Surgery, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, 6229 ER Maastricht, The Netherlands
- GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
| | - Matty P. Weijenberg
- GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, 6229 ER Maastricht, The Netherlands
| | - Martijn J. L. Bours
- GROW School for Oncology and Reproduction, 6229 ER Maastricht, The Netherlands
- Department of Epidemiology, Maastricht University, 6229 ER Maastricht, The Netherlands
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12
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Bohne A, Grundler E, Knüttel H, Fürst A, Völkel V. Influence of Laparoscopic Surgery on Cellular Immunity in Colorectal Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2023; 15:3381. [PMID: 37444491 DOI: 10.3390/cancers15133381] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/22/2023] [Accepted: 06/25/2023] [Indexed: 07/15/2023] Open
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. The main treatment options are laparoscopic (LS) and open surgery (OS), which might differ in their impact on the cellular immunity so indispensable for anti-infectious and antitumor defense. MEDLINE, Embase, Web of Science (SCI-EXPANDED), the Cochrane Library, Google Scholar, ClinicalTrials.gov, and ICTRP (WHO) were systematically searched for randomized controlled trials (RCTs) comparing cellular immunity in CRC patients of any stage between minimally invasive and open surgical resections. A random effects-weighted inverse variance meta-analysis was performed for cell counts of natural killer (NK) cells, white blood cells (WBCs), lymphocytes, CD4+ T cells, and the CD4+/CD8+ ratio. The RoB2 tool was used to assess the risk of bias. The meta-analysis was prospectively registered in PROSPERO (CRD42021264324). A total of 14 trials including 974 participants were assessed. The LS groups showed more favorable outcomes in eight trials, with lower inflammation and less immunosuppression as indicated by higher innate and adaptive cell counts, higher NK cell activity, and higher HLA-DR expression rates compared to OS, with only one study reporting lower WBCs after OS. The meta-analysis yielded significantly higher NK cell counts at postoperative day (POD)4 (weighted mean difference (WMD) 30.80 cells/µL [19.68; 41.92], p < 0.00001) and POD6-8 (WMD 45.08 cells/µL [35.95; 54.21], p < 0.00001). Although further research is required, LS is possibly associated with less suppression of cellular immunity and lower inflammation, indicating better preservation of cellular immunity.
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Affiliation(s)
- Annika Bohne
- Fakultät für Medizin, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Elena Grundler
- Fakultät für Medizin, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Helge Knüttel
- Universitätsbibliothek Regensburg, Universität Regensburg, Universitätsstraße 31, 93053 Regensburg, Germany
| | - Alois Fürst
- Caritas Krankenhaus St. Josef Regensburg, Klinik für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Landshuter Str. 65, 93053 Regensburg, Germany
| | - Vinzenz Völkel
- Tumorzentrum Regensburg-Zentrum für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053 Regensburg, Germany
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13
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Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going? Curr Oncol 2023; 30:3111-3137. [PMID: 36975449 PMCID: PMC10047700 DOI: 10.3390/curroncol30030236] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Anastomotic leakage (AL) remains one of the most severe complications following colorectal cancer (CRC) surgery. Indeed, leaks that may occur after any type of intestinal anastomosis are commonly associated with a higher reoperation rate and an increased risk of postoperative morbidity and mortality. At first, our review aims to identify specific preoperative, intraoperative and perioperative factors that eventually lead to the development of anastomotic dehiscence based on the current literature. We will also investigate the role of several biomarkers in predicting the presence of ALs following colorectal surgery. Despite significant improvements in perioperative care, advances in surgical techniques, and a high index of suspicion of this complication, the incidence of AL remained stable during the last decades. Thus, gaining a better knowledge of the risk factors that influence the AL rates may help identify high-risk surgical patients requiring more intensive perioperative surveillance. Furthermore, prompt diagnosis of this severe complication may help improve patient survival. To date, several studies have identified predictive biomarkers of ALs, which are most commonly associated with the inflammatory response to colorectal surgery. Interestingly, early diagnosis and evaluation of the severity of this complication may offer a significant opportunity to guide clinical judgement and decision-making.
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14
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Qi XY, Tan F, Liu MX, Xu K, Gao P, Yao ZD, Zhang N, Yang H, Zhang CH, Xing JD, Cui M, Su XQ. Serum and peritoneal biomarkers for the early prediction of symptomatic anastomotic leakage in patients following laparoscopic low anterior resection: A single-center prospective cohort study. Cancer Rep (Hoboken) 2023; 6:e1781. [PMID: 36718787 PMCID: PMC10075299 DOI: 10.1002/cnr2.1781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/14/2022] [Accepted: 01/02/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anastomotic leakage (AL) is one of the common complications after rectal cancer surgery. This study aimed to evaluate the combination of biomarkers for the early prediction of symptomatic AL after surgery. METHODS A prospective cohort study evaluated the serum and peritoneal biomarkers of patients who underwent laparoscopic low anterior resection (Lap LAR) from November 1, 2021, to May 1, 2022. Multivariate-penalized logistic regression was performed to explore the independent biomarker with a P-value <.1, and receiver operating characteristic (ROC) curve was used to analyze the area under the curve (AUC), sensitivity, and specificity of the independent biomarkers. A predictive model for symptomatic AL was built based on the independent biomarkers and was visualized with a nomogram. The calibration curve with the concordance index (c-index) was further applied to evaluate the efficacy of the predictive model. RESULTS A total of 157 patients were included in this study, and 7 (4.5%) were diagnosed with symptomatic AL. C-reactive protein/album ratio (CAR) on postoperative day 1 and systemic immune-inflammation index (SII) and peritoneal interleukin-6 (IL-6) on postoperative day 3 were proven to be independent predictors for the early prediction of symptomatic AL. The optimal cutoff values of CAR, SII, and peritoneal IL-6 were 1.04, 916.99, and 26430.09 pg/ml, respectively. Finally, the nomogram, including these predictors, was established, and the c-index of this nomogram was 0.812, indicating that the nomogram could be used for potential clinical reference. CONCLUSION The combination of CAR, SII, and peritoneal IL-6 might contribute to the early prediction of symptomatic AL in patients following Lap LAR. Given the limitations of this study and the emergence of other novel biomarkers, multicenter prospective studies are worthy of further exploration.
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Affiliation(s)
- Xin-Yu Qi
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Fei Tan
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Mao-Xing Liu
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Kai Xu
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Pin Gao
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Zhen-Dan Yao
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Nan Zhang
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Hong Yang
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Cheng-Hai Zhang
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Jia-Di Xing
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Ming Cui
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
| | - Xiang-Qian Su
- Department of Gastrointestinal Surgery IV, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing, People's Republic of China
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15
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Amroun K, Deguelte S, Djerada Z, Ramont L, Perrenot C, Rached L, Renard Y, Rhaiem R, Kianmanesh R. High amylase concentration in drainage liquid can early predict proximal and distal intestinal anastomotic leakages: A prospective observational study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:5. [PMID: 36974108 PMCID: PMC10039101 DOI: 10.4103/jrms.jrms_273_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/14/2021] [Accepted: 06/09/2022] [Indexed: 02/03/2023]
Abstract
Background Anastomotic leak (AL) is a serious complication in digestive surgery. Early diagnosis might allow clinicians to anticipate appropriate management. The aim of this study was to assess the predictive value of amylase concentration in drain fluid for the early diagnosis of digestive tract AL. Materials and Methods Hundred and fourteen consecutive patients "at risk" of AL, in whom a flexible drainage was placed by surgeon's choice after digestive anastomosis were included. Patients with eso-gastric, bilio-digestive, and pancreatic anastomoses were excluded. Drain amylase measurement (DAM) was routinely performed on postoperative day (POD) 1, 3, 5-7. DAM values were compared between patients with postoperative AL versus patients without AL. A receiver-operating curve (ROC) with calculation of the areas under the ROC curves area under curves was performed and a cutoff value of DAM was calculated. Results AL occurred in 25 patients (AL group) and 89 patients did not present AL (C group). The mean DAM was significantly higher in AL group versus C Group on POD 1, 3, and 5. A cutoff value of 307 IU/L predicted the occurrence of AL with a sensitivity and specificity of 91% and 100%, respectively. Positive and negative predictive values were 100% and 97.5%, respectively. Patients with AL had an elevated DAM prior to the appearance of any clinical signs of AL. Conclusion High level DAM could accurately predict AL for proximal and distal digestive tract anastomoses. This simple, noninvasive, and low-cost method can accurately predict early AL and help physicians to perform appropriate imaging and treatment.
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16
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Preoperative Immunocite-Derived Ratios Predict Surgical Complications Better when Artificial Neural Networks Are Used for Analysis-A Pilot Comparative Study. J Pers Med 2023; 13:jpm13010101. [PMID: 36675762 PMCID: PMC9861480 DOI: 10.3390/jpm13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to comparatively assess the prognostic preoperative value of the main peripheral blood components and their ratios-the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), and platelet-to-lymphocyte ratio (PLR)-to the use of artificial-neural-network analysis in determining undesired postoperative outcomes in colorectal cancer patients. Our retrospective study included 281 patients undergoing elective radical surgery for colorectal cancer in the last seven years. The preoperative values of SII, NLR, LMR, and PLR were analyzed in relation to postoperative complications, with a special emphasis on their ability to accurately predict the occurrence of anastomotic leak. A feed-forward fully connected multilayer perceptron network (MLP) was trained and tested alongside conventional statistical tools to assess the predictive value of the abovementioned blood markers in terms of sensitivity and specificity. Statistically significant differences and moderate correlation levels were observed for SII and NLR in predicting the anastomotic leak rate and degree of postoperative complications. No correlations were found between the LMR and PLR or the abovementioned outcomes. The MLP network analysis showed superior prediction value in terms of both sensitivity (0.78 ± 0.07; 0.74 ± 0.04; 0.71 ± 0.13) and specificity (0.81 ± 0.11; 0.69 ± 0.03; 0.9 ± 0.04) for all the given tasks. Preoperative SII and NLR appear to be modest prognostic factors for anastomotic leakage and overall morbidity. Using an artificial neural network offers superior prognostic results in the preoperative risk assessment for overall morbidity and anastomotic leak rate.
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17
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James TW, Edwards MJ, Nieto H, Mehanna H, Pracy P, Jennings C, Sharma N, Nankivell P. An external validation of C-reactive protein reduction as a predictor of healing following laryngopharyngectomy. Clin Otolaryngol 2022; 47:696-700. [PMID: 35899897 DOI: 10.1111/coa.13966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/04/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Tobias W James
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Michael J Edwards
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hannah Nieto
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Hisham Mehanna
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR), Birmingham, UK
| | - Paul Pracy
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Christopher Jennings
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Neil Sharma
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Paul Nankivell
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
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18
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Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy. Dis Colon Rectum 2022; 65:1335-1341. [PMID: 35358101 DOI: 10.1097/dcr.0000000000002376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Anastomotic leak is the anathema of colorectal surgery. Early diagnosis is an essential segue to early intervention. A temporary defunctioning ileostomy does not prevent an anastomotic leak and presents inherent complications of its own. Drain fluid biomarkers have been studied in colorectal surgery but not in ileal pouch surgery. OBJECTIVE This study aimed to assess drain fluid amylase as a biomarker of anastomotic leak after ileal pouch surgery and without a diverting ileostomy. DESIGN This was a multicenter prospective observational cohort study. SETTINGS The study was conducted at 4 tertiary hospitals in Queensland, Australia. PATIENTS This study included elective patients undergoing restorative proctectomy and ileal pouch surgery. INTERVENTIONS Measurement of rectal tube amylase and drain fluid amylase. MAIN OUTCOME MEASURES The primary measure was observation of increased drain fluid amylase on the day of anastomotic leak. RESULTS Fifty-three patients were studied. On the day of anastomotic leak, 4 patients in the anastomotic leak group who experienced an early anastomotic leak recorded a median drain fluid amylase of 21,897 U/L compared with a median drain fluid amylase of 25 U/L for those in the no anastomotic leak group ( p < 0.0001). LIMITATIONS This study relies on the anastomotic leak occurring while the pelvic drain is in situ. CONCLUSIONS The measurement of drain fluid amylase is a sensitive biomarker of early clinical anastomotic leak in patients undergoing restorative proctectomy with an ileal pouch and when a diverting ileostomy is not incorporated. This simple, inexpensive, and noninvasive test should be considered in all patients with ileal pouches as an adjunct to the clinical diagnosis and differentiation of anastomotic leak from other postoperative complications. See Video Abstract at http://links.lww.com/DCR/B958 .Estudio multicéntrico de la amilasa del líquido de drenaje como biomarcador para la detección de fugas anastomóticas después de una cirugía de reservorio ileal sin ileostomía de derivación. ANTECEDENTES La fuga anastomótica es el anatema de la cirugía colorrectal. El diagnóstico precoz es una transición esencial a la intervención temprana. Una ileostomía desfuncionalizante temporal no evita una fuga anastomótica y presenta sus propias complicaciones inherentes. Los biomarcadores del líquido de drenaje se han estudiado en la cirugía colorrectal, pero no en la cirugía del reservorio ileal. OBJETIVO El objetivo fue evaluar la amilasa del líquido de drenaje como biomarcador de fuga anastomótica después de cirugía de reservorio ileal y sin ileostomía de derivación. DISEO Este fue un estudio de cohorte observacional prospectivo multicéntrico. AJUSTES El estudio se realizó en 4 hospitales terciarios en Queensland, Australia. PACIENTES Se incluyeron pacientes electivos sometidos a proctectomía restauradora y cirugía de reservorio ileal. INTERVENCIONES Medición de la amilasa del tubo rectal y amilasa del líquido de drenaje. PRINCIPALES MEDIDAS DE RESULTADO La medida principal fue la observación del aumento de la amilasa en el líquido de drenaje el día de la fuga anastomótica. RESULTADOS Cincuenta y tres pacientes fueron estudiados. Los 4 pacientes que experimentaron una fuga anastomótica temprana registraron una mediana de amilasa en el líquido de drenaje de 21 897 U/L el día de la fuga anastomótica en comparación con una mediana de amilasa en el líquido de drenaje de 25 U/L para aquellos en el grupo sin fuga anastomótica (p < 0,0001). LIMITACIONES Este estudio se basa en que la anastomosis ocurre mientras el drenaje pélvico está in situ. CONCLUSIONES La medición de amilasa en el líquido de drenaje es un biomarcador sensible de fuga anastomótica clínica temprana en pacientes sometidos a proctectomía restauradora con reservorio ileal y cuando no se incorpora ileostomía derivativa. Esta prueba simple, económica y no invasiva se debe considerar en todos los pacientes con reservorio ileal como complemento del diagnóstico clínico y la diferenciación de la fuga anastomótica de otras complicaciones posoperatorias. Consulte Video Resumen en http://links.lww.com/DCR/B958 . (Traducción-Dr Yolanda Colorado ).
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The Significance of Blood and Peritoneal Fluid Biochemical Markers in Identifying Early Anastomotic Leak following Colorectal Resection-Findings from a Single-Center Study. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091253. [PMID: 36143930 PMCID: PMC9502513 DOI: 10.3390/medicina58091253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives: The aim of our study was to evaluate the value of leukocyte, C reactive protein (CRP), procalcitonin, lactate, and carcinoembryonic antigen (CEA) in blood and peritoneal fluid in early recognition of anastomotic leak (AL) after colorectal resections. Materials and Methods: Our pilot prospective cohort study was conducted at the abdominal surgery department at University Medical Center Ljubljana. A total of 43 patients who underwent open or laparoscopic colorectal resection because of benign or malignant etiology were enrolled. All of the patients had primary anastomosis without stoma formation. Results: Three patients in our patient group developed AL (7%). We found a statistically significant elevation of serum lactate levels in patients that developed AL compared to those who did not but noted no statistically relevant difference in the blood or peritoneal fluid levels of other biochemical markers. Conclusions: Elevated lactate levels may be considered a promising biomarker for the early diagnosis of AL, but more research on bigger patient groups is warranted.
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Selvamani TY, Shoukrie SI, Malla J, Venugopal S, Selvaraj R, Dhanoa RK, Zahra A, Hamouda RK, Raman A, Mostafa J. Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review. Cureus 2022; 14:e28894. [PMID: 36105895 PMCID: PMC9451042 DOI: 10.7759/cureus.28894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 01/08/2023] Open
Abstract
Leakage of the anastomotic site is considered to be one of the most serious complications after colon and rectal surgery. It is associated with increased mortality, morbidity, and longer hospital stays. This systematic review examines the need for blood markers such as C-reactive protein (CRP), procalcitonin (PCT), albumin, and various other molecular markers that assist in their propensity to diagnose anastomotic leakage (AL) early after surgery. Utilizing PubMed and Google Scholar as resources and including the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for the articles, and studies over the last five years were included. A total of 12 studies have been discussed, and most articles suggest CRP as an excellent indicator. CRP compared to Dutch leakage scores (DLS) and PCT studies suggest that the three combinations improve the predictable outcome of AL. In addition, CRP and PCT have been shown to diagnose AL early in the postoperative period. Other studies include the role of markers of oxidative stress markers, Interleukin-6, Interleukin-10, and other molecular markers in the peritoneal drain which are predictive for identifying AL after three days postoperatively (POD-3). Overall, CRP has proven to be a reliable standard indicator of diagnosis. This is because the postoperative elevation of this protein indicates a problem of leakage with clinical symptoms. Other blood parameters are useful for diagnosis as well, but the limitations are the lack of appropriate studies and the number of randomized controlled trials in this area of study.
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Jerome E, McPhail MJ, Menon K. Diagnostic accuracy of procalcitonin and interleukin-6 for postoperative infection in major gastrointestinal surgery: a systematic review and meta-analysis. Ann R Coll Surg Engl 2022; 104:561-570. [PMID: 36044921 PMCID: PMC9433179 DOI: 10.1308/rcsann.2022.0053] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2022] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND We aim to assess the diagnostic accuracy of procalcitonin (PCT) and interleukin-6 (IL-6) as diagnostic biomarkers for postoperative infection/sepsis following major abdominal surgery. Postoperative infection is an important cause for morbidity and mortality in major surgery. Early diagnosis and antimicrobial treatment improves outcomes, and high-performing biomarkers could guide clinical decision making. METHODS A systematic database search was conducted for studies reporting diagnostic performance of biomarkers (including PCT and IL-6) for infection/sepsis following major abdominal surgery. Studies were assessed for reporting of diagnostic accuracy, relevance and quality. Data were extracted for meta-analysis. RESULTS Ten studies with 1,611 participants reported the diagnostic accuracy of PCT, with pooled sensitivity, specificity and summary receiver operator curve of 72% (95% CI 66-78), 62% (95% CI 59-64) and 0.766, respectively. Four studies with 175 participants reported the diagnostic accuracy of IL-6, with pooled sensitivity, specificity and summary receiver operator curve of 84% (95% CI 72-92), 76% (95% CI 68-84) and 0.878, respectively There was variability in the timing of sampling and cut-off values and significant heterogeneity and inconsistency between studies (I2 diagnostic odds ratio (DOR)= 43.2% for PCT, I2 DOR=0% for IL-6). CONCLUSIONS PCT performs only moderately well as a diagnostic test for postoperative infection/sepsis in major abdominal surgery, demonstrating limited sensitivity and specificity. Heterogeneity between studies is a limitation of the meta-analysis. There is an ongoing need for a rapid, accurate biomarker for postoperative infection or sepsis.
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22
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Jerome E, Cavazza A, Menon K, McPhail MJ. Systematic review and meta-analysis of the diagnostic accuracy of procalcitonin for post-operative sepsis/infection in liver transplantation. Transpl Immunol 2022; 74:101675. [PMID: 35878844 DOI: 10.1016/j.trim.2022.101675] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Post-operative infection is a major cause of morbidity and mortality in Liver Transplantation (LT). Early diagnosis and antimicrobial treatment improves outcomes and ruling out sepsis aids immunosuppression decisions. Procalcitonin (PCT) has recently become part of such decision making in COVID-19 pneumonia but its role in LT is not established. We assessed the diagnostic accuracy of PCT as a diagnostic biomarker for infection or sepsis following LT. METHODS A systematic search was conducted for studies reporting diagnostic performance of PCT for infection/sepsis following LT. Studies were assessed for reporting of diagnostic accuracy, relevance and quality. RESULTS Eight studies with 363 participants reported data on the diagnostic accuracy of PCT, with pooled sensitivity, specificity, diagnostic odds ratio and summary receiver operator curve of 70% (95% CI 62-78), 77% (95% CI 73-83), 15.82 (95% CI 5.82-43.12) and 0.871 respectively. There was variability in the timing of sampling (post-operative day 1-8) and range of cut-off values (0.48 to 42.8 ng/mL). Heterogeneity was reduced when only studies with adult LT recipients were considered. CONCLUSIONS PCT performs moderately well as a diagnostic test for postoperative infection/sepsis following LT. This marker is more suited for use in adult LT populations.
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Affiliation(s)
- Ellen Jerome
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Institute of Liver Studies, Department of Inflammation Biology, School of Immunity and Microbial Sciences, Kings College London, United Kingdom.
| | - Anna Cavazza
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Institute of Liver Studies, Department of Inflammation Biology, School of Immunity and Microbial Sciences, Kings College London, United Kingdom
| | - Krishna Menon
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Institute of Liver Studies, Department of Inflammation Biology, School of Immunity and Microbial Sciences, Kings College London, United Kingdom
| | - Mark J McPhail
- Institute of Liver Studies, King's College Hospital, London, United Kingdom; Institute of Liver Studies, Department of Inflammation Biology, School of Immunity and Microbial Sciences, Kings College London, United Kingdom
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Ben-David M, Carmeli I, Orgad R, Nathansohn-Levi B, Yered T, Shor E, Wasserberg N. Implantation of an Impedance Sensor for Early Detection of Gastrointestinal Anastomotic Leaks. J Surg Res 2022; 278:49-56. [PMID: 35594614 DOI: 10.1016/j.jss.2022.04.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Accurate early diagnosis of a gastrointestinal anastomotic leak remains a challenge. When an anastomotic leak develops, the electrical properties of the tissue undergoing inflammatory processes change, resulting from the extravasation of inflammatory fluid and cellular infiltration. The method described here intends to provide a novel early anastomotic leak warning system based upon measurable changes in tissue impedance nearby an acute inflammatory process. METHODS A biodegradable Mg-alloy was compared with a nonabsorbable stainless steel (STS) electrode connected to a wireless recording system for impedance measurement. In vitro measurements were made in physiological solutions and small animal (eight mice) and large animal (eight pigs) models with an anastomotic leak simulated by an open colotomy. Measurements were made at 10 mm intervals from the open colon at baseline and up to 120 min comparing these with a sutured colonic wound and normal tissue. RESULTS In-vitro biodegradable magnesium electrode impedance evaluation showed good sensitivity to different media due to its environmental corrosion properties. The impedance of an acidic environment (1.06 ± 0.02 kΩ for citric acid) was twice that of phosphate-buffered saline (PBS) (0.64 ± 0.008 kΩ) with a distinction between Normal Saline (0.42 ± 0.013 kΩ) and PBS (0.64 ± 0.008 kΩ). This was in contrast to the performance characteristics of the control STS electrodes, where impedance in an acidic environment was lower than saline or PBS (citric acid:0.76 ± 0.01 kΩ versus PBS: 1.32 ± 0.014 kΩ). In a mouse model simulating an anastomotic leak, there was a significant increase in impedance after 120 min when compared with controls (99.7% increase versus 9.6% increase, respectively; P < 0.02). This effect was confirmed in a pig model when relative impedance measurements of the leak and control groups were compared (1.86 ± 0.46 versus 1.07 ± 0.02, respectively; P < 0.027). CONCLUSIONS Electrophysiological measurement shows diagnostic sensitivity for a gastrointestinal leak with potential clinical utility in the postoperative detection of early intra-abdominal sepsis. Further investigation of biodegradable tissue sensors capable of monitoring an early anastomotic leak is required.
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Affiliation(s)
- Matan Ben-David
- Upper GI Surgery, Royal Prince Alfred Hospital, University of Sydney, Australia.
| | - Idan Carmeli
- General Surgery, Assuta Ashdod Public Hospital, Ashdod, Israel
| | - Ran Orgad
- Department of Surgery, Rabin Medical Center, Petach Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Tal Yered
- Exero Medical LTD, Or Yehuda, Israel
| | - Erez Shor
- Exero Medical LTD, Or Yehuda, Israel
| | - Nir Wasserberg
- Department of Surgery, Rabin Medical Center, Petach Tiqva, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Guyard C, de Ponthaud C, Frontali A, Monsinjon M, Giacca M, Panis Y. C-reactive protein monitoring after ileocecal resection and stoma closure reduces length of hospital stay: a prospective case-matched study in 410 patients with Crohn's disease. Tech Coloproctol 2022; 26:443-451. [PMID: 35239097 DOI: 10.1007/s10151-022-02590-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The aim of this study was to evaluate a C-reactive protein (CRP)-driven monitoring discharge strategy for patients with Crohn's disease (CD) undergoing laparoscopic ileo-cecal resection (ICR) and if needed, temporary stoma closure (SC). METHODS Four hundred and ten patients who underwent laparoscopic ICR for CD: 153 patients (CRP group) between June 2016 and June 2020 at our department, had a CRP-driven monitoring discharge on postoperative day (POD) 3 and were discharged on POD 4 if CRP < 100 mg/L. These patients were matched (according to age, sex, body mass index, type of CD (and stoma or not) to 257 patients who underwent laparoscopic ICR for CD between January 2009 and May 2016, without CRP monitoring (Control group). For SC, 79 patients with CRP monitoring were matched with 88 control patients. Primary outcome was overall length of hospital stay (LHS). Secondary outcomes were discharge on POD 4 for SC and POD 4 and POD 6 for ICR, 3-month postoperative overall morbidity and severe morbidity rates, surgical site infection, readmission rates, and CRP level in cases of morbidity at 3 months. RESULTS For ICR without stoma, mean LHS was significantly shorter in the CRP group than in the control group (6.9 ± 2 days vs 8.3 ± 6 days, p = 0.017). Discharge occurred on POD 6 (or before) in 73% of the patients (CRP group) vs 60% (Control group) (p = 0.027). For ICR with stoma, LHS was 8 days for both groups (p = 0.612). For SC, LHS was significantly shorter in the CRP group than in the control group (5.5 ± 3 days vs 7.1 ± 4 days; p = 0.002). Discharge occurred on POD 4 in 62% (CRP group) vs 30% (Control) (p = 0.003). Postoperative 3-month overall and severe morbidity, and rehospitalization rates were similar between groups. CONCLUSIONS CRP-driven monitoring discharge strategy after laparoscopic ICR for CD is associated with a significant reduction of LHS, without increasing morbidity, reoperation or rehospitalisation rates.
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Affiliation(s)
- C Guyard
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - C de Ponthaud
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - A Frontali
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - M Monsinjon
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - M Giacca
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France
| | - Y Panis
- Department of Colorectal Surgery, DMU DIGEST, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) and University of Paris, 100 boulevard du Général Leclerc, 92118, Clichy, France.
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Diagnostic accuracy of procalcitonin on POD3 for the early diagnosis of anastomotic leakage after colorectal surgery: A meta-analysis and systematic review. Int J Surg 2022; 100:106592. [DOI: 10.1016/j.ijsu.2022.106592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/18/2022]
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The science of anastomotic healing. SEMINARS IN COLON AND RECTAL SURGERY 2022; 33. [DOI: 10.1016/j.scrs.2022.100879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Clark DA, Stevenson A, Lumley J, Petersen D, Harris C, Steffens D, Solomon M. Does an ileostomy cover the surgeon or the anastomosis? ANZ J Surg 2022; 92:19-20. [PMID: 35212109 DOI: 10.1111/ans.17364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 10/24/2021] [Indexed: 12/12/2022]
Affiliation(s)
- David A Clark
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.,Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Health, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Andrew Stevenson
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Health, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - John Lumley
- Department of Surgery, The Wesley Private Hospital, Brisbane, Queensland, Australia
| | - Damien Petersen
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Craig Harris
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Daniel Steffens
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
| | - Michael Solomon
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
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Detection of Anastomotic Leakage Following Elective Colonic Surgery: Results of the Prospective Biomarkers and Anastomotic Leakage (BALL) Study. J Surg Res 2022; 273:85-92. [PMID: 35033821 DOI: 10.1016/j.jss.2021.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 10/28/2021] [Accepted: 12/15/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Anastomotic leakage (AL) is an infrequent but life-threatening surgical complication following colorectal surgery. Early diagnosis remains clinically difficult but is a necessity to reduce associated morbidity and mortality. Clinical review and radiological modalities for the diagnosis of leakage remain non-specific and often only detect AL once it is well developed. Inflammatory biomarkers however have shown promise in early pre-clinical detection of leakage following colorectal surgery. METHODS A multi-center, prospective observational study was conducted across four public hospitals in Auckland and Christchurch, New Zealand. Consecutive adults undergoing elective colectomy were initially recruited over a 3-y period. Perioperative blood samples were collected to measure interleukin (IL)-6, IL-1β, tumor necrosis factor α, IL-10, C-reactive protein (CRP), leukocyte and neutrophil counts. Statistical analysis was performed to compare patients with an uncomplicated recovery with patients with AL. RESULTS Sixteen patients developed AL (5.7%), diagnosed at a median post-operative (POD) day 7. CRP and IL-6 were consistently elevated in the early post-operative period in patients with AL, and had the best diagnostic accuracy on POD 3 (area under the curve 0.70; P = 0.02) and POD 1 (area under the curve 0.69; P = 0.02), respectively. IL-10, once adjusted for body mass index and surgical approach, was the sole biomarker significantly elevated in patients with AL on POD 4. CONCLUSIONS Early post-operative elevations of CRP and IL-6 provide utility for early detection of AL after elective colectomy. Application of these inflammatory biomarkers and their combinations in daily practice warrants further investigation.
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Clark DA, Edmundson A, Steffens D, Harris C, Stevenson A, Solomon M. Drain fluid amylase as a biomarker for the detection of anastomotic leakage after rectal resection without a diverting ileostomy. ANZ J Surg 2022; 92:813-818. [PMID: 34994080 DOI: 10.1111/ans.17461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 12/26/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Anastomotic leak (AL) is the anathema of colorectal surgery. Early diagnosis is an essential segue to early intervention. A temporary diverting ileostomy (TDI) does not prevent an AL and presents inherent complications of its own. Numerous drain fluid biomarkers (BM) have been studied in colorectal surgery and extravasated intraluminal substances (EILS) such as amylase have shown promise. The aim of this study was to assess drain fluid amylase (DFA) as a BM of AL after minimally invasive rectal resection without a TDI. METHODS A single centre prospective cohort study performed from 2018 to 2021. The primary outcome was DFA measured daily whilst the drain was in situ. Rectal tube amylase was also measured for the first two post-operative days to quantitate the intra-luminal levels of the enzyme. DFA was compared between patients who experienced AL and those who did not. RESULTS Of the 62 patients studied, six (9.7%) experienced AL. There was a statistically significant difference in DFA between patients who experienced AL (Median:1373.5 U/L; IQR: 306-7953) and patients who did not experience an AL (Median: 27.0 U/L; IQR: 16-38); p < 0.0001. CONCLUSIONS The measurement of drain fluid amylase is a highly sensitive BM of early clinical anastomotic leak in patients undergoing a rectal resection with an extraperitoneal anastomosis and when a TDI is not incorporated. This simple, inexpensive and non-invasive test should be considered in all patients as an adjunct to the clinical diagnosis and differentiation of AL from other postoperative complications.
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Affiliation(s)
- David A Clark
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Aleksandra Edmundson
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Steffens
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Craig Harris
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Department of Surgery, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Andrew Stevenson
- Department of Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Surgery, St Vincent's Private Hospital Northside, Brisbane, Queensland, Australia
| | - Michael Solomon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, New South Wales, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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Clark DA, Steffens D, Solomon M. An umbrella systematic review of drain fluid analysis in colorectal surgery for the detection of anastomotic leak: Not yet ready to translate research studies into clinical practice. Colorectal Dis 2021; 23:2795-2805. [PMID: 34314559 DOI: 10.1111/codi.15844] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/13/2021] [Accepted: 06/28/2021] [Indexed: 02/08/2023]
Abstract
AIM Anastomotic leak (AL) is the most important complication of intestinal surgery with an anastomosis. Whilst a number of studies have defined risk factors for AL, frustratingly, low-risk patients still develop AL. Studies have looked at drain fluid analysis for detection of AL, but these findings have failed to translate into routine clinical practice. This umbrella systematic review aims to provide an overview of the promising candidate biomarkers (BMs) that show potential to translate into clinical practice. METHODS A systematic literature search was conducted in MEDLINE, EMBASE, and the Cochrane, KSR Evidence and the Epistemonikos databases on the 14 April 2021. Only systematic reviews of cohort or controlled studies measuring drain fluid biomarkers in humans were included. The methodological quality of the reviews was assessed using the AMSTAR 2 instrument. Clinical trial registries were searched for trials actively investigating drain fluid BMs. Candidate BMs were classified, and threshold values investigated. RESULTS Nine systematic reviews, published between 2007 and 2020, met the inclusion criteria, and contained a total of 36 cohort studies. A total of 38 different BMs were studied. The most promising category of drain fluid BM was the extravasated intra-luminal substances (EILS) and five registered trials of these BMs were found. Two of nine reviews were of moderate quality. CONCLUSIONS The majority of BMs show inconsistent threshold values and are in the experimental stage. A number are not readily available for adoption into routine clinical practice. Most do not state a cut-off value to be considered as diagnostic.
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Affiliation(s)
- David A Clark
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia.,University of Qld, St Lucia, Qld, Australia.,St Vincent's Private Hospital Northside, Brisbane, Qld, Australia
| | - Daniel Steffens
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael Solomon
- Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.,Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia
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31
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Shi J, Wu Z, Wu X, Shan F, Zhang Y, Ying X, Li Z, Ji J. Early Diagnosis of Anastomotic Leakage After Gastric Cancer Surgery Via Analysis of Inflammatory Factors in Abdominal Drainage. Ann Surg Oncol 2021; 29:1230-1241. [PMID: 34550478 DOI: 10.1245/s10434-021-10763-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 08/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anastomotic leakage (AL) is the most serious postoperative complication for patients with gastric cancer. We aim to develop clinically tools to detect AL in the early phase by analysis of the inflammatory factors (IFs) in abdominal drainage. METHODS We prospectively included 326 patients to establish two independent cohorts, and the concentration of IFs within abdominal drainage was detected. In the primary cohort, an IF-based AL prediction model was constructed using the least absolute shrinkage and selection operator (LASSO) regression. The predictive value of the model was later validated via the validation cohort. RESULTS Analyzing the IFs with LASSO regression, we developed an Anastomotic Score system on postoperative Day 3 (AScore-POD3), which yielded high diagnostic efficacy in the primary cohort (the area under the curve (AUC) = 0.87). The predictive value of AScore-POD3 was validated in the validation cohort, and its AUC was 0.83. We further built an AScore-POD3 based nomogram by combining the AScore-POD3 system with other clinical risk factors of AL. The C-index of the nomogram was 0.93 in the primary cohort and 0.82 in the validation cohort. CONCLUSIONS Our study suggests that AL can be early diagnosed after gastric cancer surgery by measuring drainage IFs.
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Affiliation(s)
- Jinyao Shi
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China
| | - Zhouqiao Wu
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China
| | - Xiaolong Wu
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China
| | - Fei Shan
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China
| | - Yan Zhang
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China
| | - Xiangji Ying
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China
| | - Ziyu Li
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China.
| | - Jiafu Ji
- Gastrointestinal Cancer Center, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Hai-Dian District, Beijing, People's Republic of China.
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32
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Malibary N, Saleem A, Almuttawa A, Delhorme J, Manfredelli S, Romain B, Brigand C, Rohr S. Evaluating
Dutch Leakage Scores
in diagnosing anastomotic leak in colorectal surgery. SURGICAL PRACTICE 2021. [DOI: 10.1111/1744-1633.12509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nadim Malibary
- Department of Surgery King Abdulaziz University Jeddah Saudi Arabia
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
| | - Abdulaziz Saleem
- Department of Surgery King Abdulaziz University Jeddah Saudi Arabia
| | - Abdullah Almuttawa
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
- Department of Surgery Jeddah University Jeddah Saudi Arabia
| | - Jean‐Baptiste Delhorme
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
| | - Simone Manfredelli
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
| | - Benoit Romain
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
| | - Cecile Brigand
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
| | - Serge Rohr
- Department of General and Digestive Surgery Hautepierre University Hospital Strasbourg France
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33
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Procalcitonin and C-Reactive Protein as an Early Predictor of Infection in Elective Gastrointestinal Cancer Surgery-a Prospective Observational Study. J Gastrointest Cancer 2021; 53:605-613. [PMID: 34328613 DOI: 10.1007/s12029-021-00661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Postoperative infections are a common entity following elective gastrointestinal surgery among which intra-abdominal infection is notorious and life threatening. Early detection could reduce postoperative morbidity and permit safe and early discharge. This study was aimed to establish the usefulness of procalcitonin (PCT) and C-reactive protein (CRP) on postoperative day 3 as reliable markers for early detection of intra-abdominal infection and other postoperative infections following elective gastrointestinal cancer surgery. METHODS A total of 125 patients following elective gastrointestinal cancer surgery were prospectively observed until discharge from January 2018 to December 2019. The incidence of intra-abdominal infections and other postoperative infections was recorded. Serum PCT and CRP were estimated on postoperative day 3 for all the patients. ROC analysis of PCT and CRP was performed to establish their predictability in detecting these infections. Risk factors for postoperative infections were also studied. RESULTS The incidence of intra-abdominal infection (IAI) was 24%. The difference in PCT between the infected and non-infected patients was statistically significant (p = 0.001) but not in CRP (p = 0.223). On ROC analysis of CRP and PCT in detecting IAI, the areas under the curve were 0.494 and 0.615 respectively. CONCLUSION Raised serum PCT values on postoperative day 3 indicate the presence of infections and should prompt the surgeon to consider other investigations to confirm the presence of IAI and other postoperative infections and plan early intervention thus expediting the postoperative recovery. CLINICAL TRIAL REGISTRATION NUMBER CTRI/2018/12/016695.
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34
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Schwartz-Lasfargues C, Roux-Gendron C, Edomskis P, Marque I, Bayon Y, Lange JF, Faucheron JL, Trilling B. Early User Centred Design during development of an innovative medical device: case study of a connected Sensor System in colorectal surgery (Preprint). JMIR Hum Factors 2021; 9:e31529. [PMID: 35802406 PMCID: PMC9308077 DOI: 10.2196/31529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/23/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background A successful innovative medical device is not only technically challenging to develop but must also be readily usable to be integrated into health care professionals’ daily practice. Through a user-centered design (UCD) approach, usability can be improved. However, this type of approach is not widely implemented from the early stages of medical device development. Objective The case study presented here shows how UCD may be applied at the very early stage of the design of a disruptive medical device used in a complex hospital environment, while no functional device is available yet. The device under study is a connected sensor system to detect colorectal anastomotic leakage, the most detrimental complication following colorectal surgery, which has a high medical cost. We also aimed to provide usability guidelines for the initial design of other innovative medical devices. Methods UCD was implemented by actively involving health care professionals and all the industrial partners of the project. The methodology was conducted in 2 European hospitals: Grenoble-Alpes University Hospital (France) and Erasmus Medical Center Rotterdam (the Netherlands). A total of 6 elective colorectal procedures and 5 ward shifts were observed. In total, 4 workshops were conducted with project partners and clinicians. A formative evaluation was performed based on 5 usability tests using nonfunctional prototype systems. The case study was completed within 12 months. Results Functional specifications were defined for the various components of the medical device: device weight, size, design, device attachment, and display module. These specifications consider the future integration of the medical device into current clinical practice (for use in an operating room and patient follow-up inside the hospital) and interactions between surgeons, nurses, nurse assistants, and patients. By avoiding irrelevant technical development, this approach helps to promote cost-effective design. Conclusions This paper presents the successful deployment over 12 months of a UCD methodology for the design of an innovative medical device during its early development phase. To help in reusing this methodology to design other innovative medical devices, we suggested best practices based on this case.
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Affiliation(s)
- Christel Schwartz-Lasfargues
- Public Health Department, CHU Grenoble Alpes, Grenoble, France
- Inserm CIC 1406, Université Grenoble Alpes, Grenoble, France
| | | | - Pim Edomskis
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Isabelle Marque
- Public Health Department, CHU Grenoble Alpes, Grenoble, France
- Inserm CIC 1406, Université Grenoble Alpes, Grenoble, France
| | - Yves Bayon
- Medtronic - Sofradim Production, Trevoux, France
| | - Johan F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - Jean Luc Faucheron
- Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, CHU Grenoble Alpes, Grenoble, France
- TIMC, Université Grenoble Alpes, Centre National de Recherche Scientifique, Grenoble INP, Grenoble, France
| | - Bertrand Trilling
- Colorectal Surgery Unit, Visceral Surgery and Acute Care Surgery Department, CHU Grenoble Alpes, Grenoble, France
- TIMC, Université Grenoble Alpes, Centre National de Recherche Scientifique, Grenoble INP, Grenoble, France
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35
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Namba Y, Mukai S, Saito Y, Moriuchi T, Bekki T, Okimoto S, Oishi K, Fujisaki S, Takahashi M, Fukuda T, Egi H, Ohdan H. Risk Factors for Anastomotic Leakage after Colorectal Surgery with Double-staple Technique Anastomosis: Impact of the Agatston Score. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:181-187. [PMID: 33937559 PMCID: PMC8084537 DOI: 10.23922/jarc.2020-099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 02/03/2021] [Indexed: 01/23/2023]
Abstract
Objectives Anastomotic leakage is associated with severe morbidity, mortality, and functional defects. Its risk factors remain unclear. However, blood perfusion may be a potential major risk factor. It has been reported that the Agatston score is an index for blood flow perfusion evaluation. Therefore, we evaluated the clinical indicators associated with anastomotic leakage, including the Agatston score, in patients who underwent colorectal surgery. Methods We retrospectively analyzed 147 patients who underwent elective colorectal surgery with the double-staple technique anastomosis for colorectal cancer between April 2015 and March 2020. The primary outcome was the presence or absence of anastomotic leakage. Univariate and multivariate analyses were employed to identify pre- and intraoperative risk factors. Results Of the 147 patients analyzed, anastomotic leakage occurred in 12 (8.16%). Male gender, history of angina and myocardial infarction, preoperative white blood cell count, the Agatston score, extent of bleeding, operation time, and intraoperative fluid volume were significantly related to a higher incidence of anastomotic leakage in univariate analysis. Multivariate analysis demonstrated that the incidence of anastomotic leakage was high in patients with a high Agatston score. Conclusions The Agatston score can predict the incidence of anastomotic leakage in patients following colorectal surgery. Thus, perioperative measures to prevent anastomotic leakage are recommended when a high Agatston score is observed. A prospective trial is required to demonstrate, with a high level of evidence, that the Agatston score can be useful as a risk score for anastomotic leakage following colorectal surgery.
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Affiliation(s)
- Yosuke Namba
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Shoichiro Mukai
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Yasufumi Saito
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | - Tomoaki Bekki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Sho Okimoto
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Koichi Oishi
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | - Seiji Fujisaki
- Department of Surgery, Chugoku Rosai Hospital, Hiroshima, Japan
| | | | | | - Hiroyuki Egi
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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36
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Pischke SE, Hødnebø S, Wester T, Haugaa H, Kvernebo K, Barratt-Due A, Tønnessen TI. Intraperitoneal microdialysis detects intestinal leakage earlier than hemodynamic surveillance and systemic inflammation in a pig model. Scand J Gastroenterol 2021; 56:219-227. [PMID: 33356757 DOI: 10.1080/00365521.2020.1863459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Anastomotic leakage is a common complication following large abdominal surgery, often developing to life-threatening abdominal sepsis due to late diagnosis. Currently, diagnostics rely on systemic hemodynamic and infection monitoring. We hypothesized that intraperitoneal microdialysis allows detection of peritonitis prior to changes in standard clinical parameters in a pig model. MATERIALS AND METHODS We included six pigs; five underwent intraperitoneal fecal contamination, one had sham surgery for a total of 10 h. Microdialysis was established in four intraabdominal quadrants and two hepatic lobes. All pigs were hemodynamically monitored with pulmonary artery and femoral artery catheters. Blood samples were assessed for inflammatory markers, terminal complement complex (TCC), interleukin (IL)-6, IL-10, and plasminogen activator inhibitor-1 (PAI-1). RESULTS Microdialysis showed intraperitoneal lactate increase during the first two hours after fecal contamination, which remained elevated throughout the observation time with concurrent decrease of glucose. Arterial lactate remained within reference range (<1,6mM). Systemic inflammatory markers TCC, IL-6, IL-10 and PAI-1 increased significantly after minimum four hours. Mean arterial pressure, stroke volume variation and cardiac output were not compromised the first five hours. Sham surgery did not influence any of the parameters. CONCLUSION Intraperitoneal fecal contamination leads to a rapid and pronounced intraperitoneal increase in lactate, decrease in glucose while pyruvate and glycerol levels remain unchanged. This distinct metabolic pattern of peritoneal inflammation can be easily detected by microdialysis. Observation of this pattern may minimize time to safe diagnosis of intestinal perforations after intraperitoneal fecal contamination.
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Affiliation(s)
- Soeren Erik Pischke
- Division of Emergencies and Intensive Care, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Immunology, Oslo, Norway
| | - Stina Hødnebø
- Division of Emergencies and Intensive Care, Oslo, Norway
| | - Torjus Wester
- Department of Cardio-thoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Håkon Haugaa
- Division of Emergencies and Intensive Care, Oslo, Norway
| | - Knut Kvernebo
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Cardio-thoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Andreas Barratt-Due
- Division of Emergencies and Intensive Care, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Immunology, Oslo, Norway
| | - Tor Inge Tønnessen
- Division of Emergencies and Intensive Care, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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37
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Daniel VT, Alavi K, Davids JS, Harnsberger CR, Maykel JA. Defining Anastomotic Leaks After Colorectal Surgery: Results of a National Survey. J Surg Res 2021; 261:242-247. [PMID: 33460969 DOI: 10.1016/j.jss.2020.11.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 09/11/2020] [Accepted: 11/01/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Anastomotic leaks are a dreaded complication after colorectal surgery. Although anastomotic leak is often used as a metric to compare patient outcomes, a standard definition does not exist. MATERIALS AND METHODS A web-based survey was developed and distributed to US surgeons. Respondents were queried on the definition of anastomotic leaks using a 5-point Likert scale to rate different scenarios related to colorectal surgery. RESULTS Of potential 2209 respondents, 649 (29%) responded to the survey. The majority of respondents was men (76%) and practiced colon and rectal surgery as their primary specialty (89%). Contrast extravasation at the anastomosis, regardless of timing related to the surgery, is the clinical scenario with greatest consensus (>85%). 50% of surgeons do not believe that an abscess near the anastomosis in an asymptomatic patient defines a leak. CONCLUSIONS These results highlight the pressing need for standardization of the anastomotic leak definition given the implications on outcomes measurement, research trials, and health care reimbursement.
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Affiliation(s)
- Vijaya T Daniel
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Karim Alavi
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jennifer S Davids
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Cristina R Harnsberger
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Justin A Maykel
- Division of Colon and Rectal Surgery, Department of Surgery, University of Massachusetts Medical School, Worcester, Massachusetts.
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38
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Clark DA, Yeoh E, Edmundson A, Harris C, Stevenson A, Steffens D, Solomon M. A Development study of Drain Fluid Gastrografin as a Biomarker of Anastomotic Leak. Ann Coloproctol 2021; 38:124-132. [PMID: 33445840 PMCID: PMC9021859 DOI: 10.3393/ac.2020.12.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/24/2020] [Indexed: 11/08/2022] Open
Abstract
Purpose Anastomotic leakage (AL) is the anathema of colorectal surgery. Its occurrence leads to increased morbidity and mortality and a prolonged hospital stay. Much work has gone into studying various biomarkers in drain fluid to facilitate early detection of AL. This stage 2a development study aims to assess the safety and feasibility of reliably detecting the iodine in Gastrografin (GG; Bayer Australia Ltd.) in drain fluid and stool samples by dual-energy computed tomography (DECT). Methods This is a prospective, observational, controlled, consecutive cohort study establishing the safety and feasibility of the detection of GG in surgical drain fluid and stool as a biomarker of AL when patients with a low pelvic colorectal anastomosis undergo luminal flushing of the rectal tube with GG. Results Ten consecutive patients were allocated to the saline flush group and the following 10 to the GG flush group. Three patients in the saline flush group developed an AL. One patient in the GG flush group developed an AL. An elevation in the drain fluid GG was detected using DECT on the day of clinical deterioration. None of the patients in the control group were found to have a positive result on DECT. Conclusion This study demonstrates the safety of a novel approach to the early detection of AL from extraperitoneal colorectal anastomoses. The technique requires validation in a larger cohort and a multicenter study is planned to investigate the efficacy of GG rectal tube flushes as an early biomarker of AL in low pelvic anastomoses.
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Affiliation(s)
- David A Clark
- Faculty of Medicine and Health, University of Sydney, and Surgical Outcomes Research Centre (SOuRCe) Missenden Road, Camperdown, Sydney, NSW 2050.,Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD 4066.,University of Qld, St Lucia, Brisbane 4072.,St Vincent's Private Hospital Northside, 627 Rode Road, Brisbane, QLD 4032
| | - Edward Yeoh
- Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba QLD 4102
| | - Aleksandra Edmundson
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD 4066.,University of Qld, St Lucia, Brisbane 4072
| | - Craig Harris
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD 4066.,St Vincent's Private Hospital Northside, 627 Rode Road, Brisbane, QLD 4032
| | - Andrew Stevenson
- Royal Brisbane and Women's Hospital, Herston Road, Brisbane, QLD 4066.,University of Qld, St Lucia, Brisbane 4072.,St Vincent's Private Hospital Northside, 627 Rode Road, Brisbane, QLD 4032
| | - Daniel Steffens
- Faculty of Medicine and Health, University of Sydney, and Surgical Outcomes Research Centre (SOuRCe) Missenden Road, Camperdown, Sydney, NSW 2050
| | - Michael Solomon
- Faculty of Medicine and Health, University of Sydney, and Surgical Outcomes Research Centre (SOuRCe) Missenden Road, Camperdown, Sydney, NSW 2050
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39
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Edomskis P, Goudberg MR, Sparreboom CL, Menon AG, Wolthuis AM, D’Hoore A, Lange JF. Matrix metalloproteinase-9 in relation to patients with complications after colorectal surgery: a systematic review. Int J Colorectal Dis 2021; 36:1-10. [PMID: 32865714 PMCID: PMC7782374 DOI: 10.1007/s00384-020-03724-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Anastomotic leakage (AL) is the most severe complication following colorectal resection and is associated with increased mortality. The main group of enzymes responsible for collagen and protein degradation in the extracellular matrix is matrix metalloproteinases. The literature is conflicting regarding anastomotic leakage and the degradation of extracellular collagen by matrix metalloproteinase-9 (MMP-9). In this systematic review, the possible correlation between anastomotic leakage after colorectal surgery and MMP-9 activity is investigated. METHODS Embase, MEDLINE, Cochrane, and Web of Science databases were searched up to 3 February 2020. All published articles that reported on the relationship between MMP-9 and anastomotic leakage were selected. Both human and animal studies were found eligible. The correlation between MMP-9 expression and anastomotic leakage after colorectal surgery. RESULTS Seven human studies and five animal studies were included for analysis. The human studies were subdivided into those assessing MMP-9 in peritoneal drain fluid, intestinal biopsies, and blood samples. Five out of seven human studies reported elevated levels of MMP-9 in patients with anastomotic leakage on different postoperative moments. The animal studies demonstrated that MMP-9 activity was highest in the direct vicinity of an anastomosis. Moreover, MMP-9 activity was significantly reduced in areas further proximally and distally from the anastomosis and was nearly or completely absent in uninjured tissue. CONCLUSION Current literature shows some relation between MMP-9 activity and colorectal AL, but the evidence is inconsistent. Innovative techniques should further investigate the value of MMP-9 as a clinical biomarker for early detection, prevention, or treatment of AL.
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Affiliation(s)
- Pim Edomskis
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Max R. Goudberg
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Cloë L. Sparreboom
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Anand G. Menon
- grid.414559.80000 0004 0501 4532Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
| | - Albert M. Wolthuis
- grid.410569.f0000 0004 0626 3338Departmenf of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Andre D’Hoore
- grid.410569.f0000 0004 0626 3338Departmenf of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Johan F. Lange
- grid.5645.2000000040459992XDepartment of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands ,grid.414559.80000 0004 0501 4532Department of Surgery, IJsselland Ziekenhuis, Capelle aan den IJssel, The Netherlands
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40
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Twohig K, Ajith A, Mayampurath A, Hyman N, Shogan BD. Abnormal vital signs after laparoscopic colorectal surgery: More common than you think. Am J Surg 2020; 221:654-658. [PMID: 32847687 DOI: 10.1016/j.amjsurg.2020.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anastomotic leak is a feared complication. The presence of abnormal vital signs is often cited as an important overlooked predictive clue in retrospective settings once the diagnosis of leak has already been established. We aimed to determine the prevalence of abnormal vital signs following colorectal resection and assess its predictive value. METHODS We retrospectively studied patients undergoing colorectal resection. The performance of vital signs in predicting anastomotic leak was assessed using discrete-time survival analysis and receiver operator characteristic curve. RESULTS 1662 patients (841 laparoscopic, 821 open) were included. Clinical anastomotic leak was diagnosed in 50 patients (3.1%). 96.8% of patients of the entire cohort had at least one abnormal vital sign during their postoperative course. No individual vital sign was a strong predictor of anastomotic leak in either laparoscopic or open cohorts. CONCLUSION Vital sign abnormalities are extremely common following open and laparoscopic colorectal surgery and alone are poor predictors of anastomotic leak.
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Affiliation(s)
- Kelly Twohig
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Aswathy Ajith
- Center for Research Informatics, University of Chicago, Chicago, IL, USA
| | | | - Neil Hyman
- Division of Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA
| | - Benjamin D Shogan
- Division of Colon and Rectal Surgery, University of Chicago, Chicago, IL, USA.
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41
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van Helsdingen CPM, Jongen ACHM, de Jonge WJ, Bouvy ND, Derikx JPM. Consensus on the definition of colorectal anastomotic leakage: A modified Delphi study. World J Gastroenterol 2020; 26:3293-3303. [PMID: 32684743 PMCID: PMC7336323 DOI: 10.3748/wjg.v26.i23.3293] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/14/2020] [Accepted: 05/27/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite the emerging knowledge about colorectal anastomotic leakage (CAL) through the increasing number of clinical and experimental studies, there is no generally accepted definition of CAL. Because of the wide variety of definitions used in literature, comparison of study outcomes and quality of care is complicated.
AIM To reach consensus on the definition of CAL using a modified Delphi method.
METHODS The RAND/UCLA appropriateness method was used. The expert panel consisted of international colorectal surgeons and researchers who had published three or more articles about CAL. The consensus process consisted of two online distributed questionnaires and a third round with a recommendation. In the questionnaires participants were asked to rate the appropriateness of statements using a 1-9 Likert scale. Consensus was defined as a panel median between 1-3 or 7-9 without disagreement. In the final round a recommendation was formed regarding the definition of CAL and the expert panel was asked if they agreed or disagreed.
RESULTS Twenty-three authors participated in the first round and twenty-one finished the second round. After two rounds consensus was reached on 37 items (80%) in nine different categories. The International Study Group of Rectal Cancer definition is the most frequently advised general definition by our panel. Consensus was reached regarding the clinical symptoms of CAL, which serum markers contributes to the suspicion of CAL, which radiological and perioperative findings should be considered as CAL, which grading system is appropriate and if there should be a range of postoperative days in the definition. Eventually, 19 experts completed all three rounds of which 16 (84%) agreed with our final recommendations for the definition of CAL.
CONCLUSION A consensus-based recommendation for the definition of CAL was formed using our modified Delphi method that can be widely incorporated in the field.
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Affiliation(s)
- Claire PM van Helsdingen
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam 1105 AZ, Netherlands
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 BK, Netherlands
| | - Audrey CHM Jongen
- Department of Surgery, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Wouter J de Jonge
- Tytgat Institute for Liver and Intestinal Research, Amsterdam UMC, University of Amsterdam, Amsterdam 1105 BK, Netherlands
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn 53127, Germany
| | - Nicole D Bouvy
- Department of Surgery, Maastricht University Medical Center, Maastricht 6202 AZ, Netherlands
| | - Joep PM Derikx
- Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam 1105 AZ, Netherlands
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42
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Paliogiannis P, Deidda S, Maslyankov S, Paycheva T, Farag A, Mashhour A, Misiakos E, Papakonstantinou D, Mik M, Losinska J, Scognamillo F, Sanna F, Feo CF, Cherchi G, Xidas A, Zinellu A, Restivo A, Zorcolo L. Blood cell count indexes as predictors of anastomotic leakage in elective colorectal surgery: a multicenter study on 1432 patients. World J Surg Oncol 2020; 18:89. [PMID: 32375770 PMCID: PMC7204308 DOI: 10.1186/s12957-020-01856-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 04/17/2020] [Indexed: 02/07/2023] Open
Abstract
Background The aim of this study was to evaluate a series of blood count inflammation indexes in predicting anastomotic leakage (AL) in elective colorectal surgery. Methods Demographic, pathologic, and clinical data of 1432 consecutive patients submitted to colorectal surgery in eight surgical centers were retrospectively evaluated. The neutrophil to lymphocyte (NLR), derived neutrophil to lymphocyte (dNLR), lymphocyte to monocyte (LMR), and platelet to lymphocyte (PLR) ratios were calculated before surgery and on the 1st and 4th postoperative days, in patients with or without AL. Results There were 106 patients with AL (65 males, mean age 67.4 years). The NLR, dNLR, and PLR were significantly higher in patients with AL in comparison to those without, on both the 1st and 4th postoperative days, but significance was greater on the 4th postoperative day. An NLR cutoff value of 7.1 on this day showed the best area under the curve (AUC 0.744; 95% CI 0.719–0.768) in predicting AL. Conclusions Among the blood cell indexes of inflammation evaluated, NLR on the 4th postoperative day showed the best ability to predict AL. NLR is a low cost, easy to perform, and widely available index, which might be potentially used in clinical practice as a predictor of AL in patients undergoing elective colorectal surgery.
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Affiliation(s)
- Panagiotis Paliogiannis
- Experimental Pathology and Oncology, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy.
| | - Simona Deidda
- Colorectal Surgery Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, 09042, Cagliari, Italy
| | - Svilen Maslyankov
- Second Surgery Clinic, Department of Surgery, Medical University of Sofia, G.Sofijski str. 1, 1404, Sofia, Bulgaria
| | - Tsvetelina Paycheva
- Second Surgery Clinic, Department of Surgery, Medical University of Sofia, G.Sofijski str. 1, 1404, Sofia, Bulgaria
| | - Ahmed Farag
- Colorectal Surgery Unit, General Surgery Department, Faculty of Medicine, Cairo University, Kaser Alainy Hospital, 89 Almanial, Cairo, Egypt
| | - Abdrabou Mashhour
- Colorectal Surgery Unit, General Surgery Department, Faculty of Medicine, Cairo University, Kaser Alainy Hospital, 89 Almanial, Cairo, Egypt
| | - Evangelos Misiakos
- Third Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Dimitrios Papakonstantinou
- Third Department of Surgery, Attikon University Hospital, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Michal Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland
| | - Joanna Losinska
- Department of General and Colorectal Surgery, Medical University of Lodz, Plac Hallera 1, 90-647, Lodz, Poland
| | - Fabrizio Scognamillo
- First Surgery Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Fabio Sanna
- First Surgery Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Claudio Francesco Feo
- Second Surgery Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Giuseppe Cherchi
- Second Surgery Clinic, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Andreas Xidas
- Unit of Surgery, Nostra Signora della Mercede Hospital of Lanusei, Via Ospedale, 08045, Lanusei, Italy
| | - Angelo Zinellu
- Clinical Biochemistry and Clinical Molecular Biology, Department of Biomedical Sciences, University of Sassari, Viale San Pietro 43, 07100, Sassari, Italy
| | - Angelo Restivo
- Colorectal Surgery Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, 09042, Cagliari, Italy
| | - Luigi Zorcolo
- Colorectal Surgery Unit, Department of Surgical Sciences, University of Cagliari, Monserrato, 09042, Cagliari, Italy
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43
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Du CZ, Fan ZH, Yang YF, Yuan P, Gu J. Value of intra-operative Doppler sonographic measurements in predicting post-operative anastomotic leakage in rectal cancer: a prospective pilot study. Chin Med J (Engl) 2020; 132:2168-2176. [PMID: 31461731 PMCID: PMC6797145 DOI: 10.1097/cm9.0000000000000410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Anastomotic leakage is a serious surgical complication in rectal cancer; however, effective evaluation methods for predicting anastomotic leakage individual risk in patients are not currently available. This study aimed to develop a method to evaluate the risk of leakage during surgery. METHODS The 163 patients with rectal cancer, who had undergone anterior resection and low-ligation procedures for Doppler sonographic hemodynamic measurement from April 2011 to January 2015 in Peking University Cancer Hospital, were prospectively recruited. A predictive model was constructed based on the associations between anastomotic leakage and alterations in the anastomotic blood supply in the patients, using both univariate and multivariate statistical analyses, as well as diagnostic methodology evaluation, including Chi-square test, logistic regression model, and receiver operating characteristic curve. RESULTS The overall anastomotic leakage incidence was 9.2% (15/163). Doppler hemodynamic parameters whose reduction was significantly associated with anastomotic leakage were peak systolic velocity, pulsatility index, and resistance index. The areas under the receiver operating characteristic curve of residual rates of peak systolic velocity, pulsatility index, and resistance index in predicting anastomotic leakage were 0.703 (95% confidence interval [CI]: 0.552-0.854), 0.729 (95% CI: 0.579-0.879), and 0.689 (95% CI: 0.522-0.856), respectively. The predictive model revealed that the patients with severely reduced blood-flow signal exhibited a significantly higher incidence rate of anastomotic leakage than those with sufficient blood supply (19.6% vs. 3.7%, P = 0.003), particularly the patients with low rectal cancer (25.9% vs. 3.9%, P = 0.007) and those receiving neoadjuvant chemoradiotherapy (32.1% vs. 3.7%, P = 0.001), independent of prophylactic ileostoma. Multivariate analysis revealed that insufficient blood supply of the anastomotic bowel was an independent risk factor for anastomotic leakage (odds ratio: 10.37, 95% CI: 2.703-42.735, P = 0.001). CONCLUSION Based on this explorative study, Doppler sonographic hemodynamic measurement of the anastomotic bowel presented potential value in predicting anastomotic leakage.
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Affiliation(s)
- Chang-Zheng Du
- Gastrointestinal Cancer Center, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China.,Department of Pathology, Duke University Medical School, Durham, NC, USA
| | - Zhi-Hui Fan
- Department of Sonography, Peking University Cancer Hospital, Beijing 100142, China
| | - Yuan-Fan Yang
- Department of Pathology, Duke University Medical School, Durham, NC, USA
| | - Ping Yuan
- Peking University Shougang Hospital, Beijing 100144, China
| | - Jin Gu
- Gastrointestinal Cancer Center, Peking University Cancer Hospital, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Beijing 100142, China.,Peking University Shougang Hospital, Beijing 100144, China.,Peking-Tsinghua Joint Center for Life Sciences, Beijing 100871, China
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44
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Plas M, Rutgers A, van der Wal-Huisman H, de Haan JJ, Absalom AR, de Bock GH, van Leeuwen BL. The association between the inflammatory response to surgery and postoperative complications in older patients with cancer; a prospective prognostic factor study. J Geriatr Oncol 2020; 11:873-879. [PMID: 32035801 DOI: 10.1016/j.jgo.2020.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/26/2020] [Accepted: 01/26/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Accurate prognostic biomarkers would substantially improve surgical planning and decisions making yet no studies have been reported exploring the inflammatory response in surgically treated older patients with cancer. The aim of this study was to explore inflammatory biomarkers as potential prognostic factors for postoperative complications within 30 days in older patients with cancer. METHOD Patients 65 years and older undergoing surgery for removal of a solid malignant tumour were included in an observational cohort study. All complications occurring up to 30 days postoperatively were documented prospectively. Inflammatory markers were measured in plasma samples pre- and postoperatively: C-reactive protein (CRP), Interleukin-1 beta (IL-1β), IL-6, IL-10, IL-12, and Tumour necrosis factor-alpha (TNF-α). Associations between inflammatory markers and postoperative complications were explored using logistic regression analysis. RESULTS Between July 2010 and April 2014, plasma samples of 224 patients were collected. Median age was 72 (65-89) years and 116 (51.8%) patients were female. Approximately half of the patients developed postoperative complications (49.6%) of whom 62 patients (55.9%) developed >1 complication. An independent prognostic effect was observed for the inflammatory biomarkers IL-6 and IL-10 for the occurrence of postoperative complications. CONCLUSION The perioperative inflammatory response is associated with complications, independently from patient and surgical factors which are also associated with outcome. Research is warranted towards further exploration of the perioperative inflammatory response with the aim to improve perioperative care and outcome, and might help to improve surgical planning and decision making for older patients with cancer.
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Affiliation(s)
- Matthijs Plas
- University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9700, RB, Groningen, the Netherlands.
| | - Abraham Rutgers
- University of Groningen, University Medical Center Groningen, Department of Rheumatology and Clinical Immunology, Hanzeplein 1, 9700, RB, Groningen, the Netherlands
| | - Hanneke van der Wal-Huisman
- University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9700, RB, Groningen, the Netherlands
| | - Jacco J de Haan
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Hanzeplein 1, 9700, RB, Groningen, the Netherlands
| | - Anthony R Absalom
- University of Groningen, University Medical Center Groningen, Department of Anesthesiology, Hanzeplein 1, 9700, RB, Groningen, the Netherlands
| | - Geertruida H de Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9700, RB, Groningen, the Netherlands
| | - Barbara L van Leeuwen
- University of Groningen, University Medical Center Groningen, Department of Surgery, Hanzeplein 1, 9700, RB, Groningen, the Netherlands
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45
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Messias BA, Botelho RV, Saad SS, Mocchetti ER, Turke KC, Waisberg J. Serum C-reactive protein is a useful marker to exclude anastomotic leakage after colorectal surgery. Sci Rep 2020; 10:1687. [PMID: 32015374 PMCID: PMC6997159 DOI: 10.1038/s41598-020-58780-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 01/21/2020] [Indexed: 01/16/2023] Open
Abstract
Anastomotic leakage is a complication of colorectal surgery. C-reactive protein (CRP) is an acute-phase marker that can indicate surgical complications. We determined whether serum CRP levels in patients who had undergone colorectal surgery can be used to exclude the presence of anastomotic leakage and allow safe early discharge. We included 90 patients who underwent colorectal surgery with primary anastomosis. Serum CRP levels were measured retrospectively on postoperative days (PODs) 1 - 7. Patients with anastomotic leakage (n = 11) were compared to those without leakage (n = 79). We statistically analysed data and plotted receiver operating characteristic curves. The incidence of anastomotic leakage was 12.2%. Diagnoses were made on PODs 3 - 24. The overall mortality rate was 3.3% (18.2% in the leakage group, 1.3% in the non-leakage group; P < 0.045). CRP levels were most accurate on POD 4, with a cutoff level of 180 mg/L, showing an area under the curve of 0.821 and a negative predictive value of 97.2%. Lower CRP levels after POD 2 and levels <180 mg/L on POD 4 may indicate the absence of anastomotic leakage and may allow safe discharge of patients who had undergone colorectal surgery with primary anastomosis.
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Affiliation(s)
- Bruno A Messias
- Department of Surgery, General Hospital of Carapicuiba, Carapicuiba, SP, Brazil.
| | - Ricardo V Botelho
- Department of Surgery, State Public Servant Hospital (IAMSPE), São Paulo, SP, Brazil
| | - Sarhan S Saad
- Department of Surgery, Paulista Medical School, Federal University of São Paulo, São Paulo, SP, Brazil
| | - Erica R Mocchetti
- Department of Surgery, General Hospital of Carapicuiba, Carapicuiba, SP, Brazil
| | - Karine C Turke
- Department of Surgery, State Public Servant Hospital (IAMSPE), São Paulo, SP, Brazil.,Department of Surgery, ABC Medical School, Santo André, SP, Brazil
| | - Jaques Waisberg
- Department of Surgery, State Public Servant Hospital (IAMSPE), São Paulo, SP, Brazil.,Department of Surgery, ABC Medical School, Santo André, SP, Brazil
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46
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Sparreboom CL, Komen N, Rizopoulos D, Verhaar AP, Dik WA, Wu Z, van Westreenen HL, Doornebosch PG, Dekker JWT, Menon AG, Daams F, Lips D, van Grevenstein WMU, Karsten TM, Bayon Y, Peppelenbosch MP, Wolthuis AM, D'Hoore A, Lange JF. A multicentre cohort study of serum and peritoneal biomarkers to predict anastomotic leakage after rectal cancer resection. Colorectal Dis 2020; 22:36-45. [PMID: 31344302 PMCID: PMC6973162 DOI: 10.1111/codi.14789] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022]
Abstract
AIM Anastomotic leakage (AL) is one of the most feared complications after rectal resection. This study aimed to assess a combination of biomarkers for early detection of AL after rectal cancer resection. METHOD This study was an international multicentre prospective cohort study. All patients received a pelvic drain after rectal cancer resection. On the first three postoperative days drain fluid was collected daily and C-reactive protein (CRP) was measured. Matrix metalloproteinase-2 (MMP2), MMP9, glucose, lactate, interleukin 1-beta (IL1β), IL6, IL10, tumour necrosis factor alpha (TNFα), Escherichia coli, Enterococcus faecalis, lipopolysaccharide-binding protein and amylase were measured in the drain fluid. Prediction models for AL were built for each postoperative day using multivariate penalized logistic regression. Model performance was estimated by the c-index for discrimination. The model with the best performance was visualized with a nomogram and calibration was plotted. RESULTS A total of 292 patients were analysed; 38 (13.0%) patients suffered from AL, with a median interval to diagnosis of 6.0 (interquartile ratio 4.0-14.8) days. AL occurred less often after partial than after total mesorectal excision (4.9% vs 15.2%, P = 0.035). Of all patients with AL, 26 (68.4%) required reoperation. AL was more often treated by reoperation in patients without a diverting ileostomy (18/20 vs 8/18, P = 0.03). The prediction model for postoperative day 1 included MMP9, TNFα, diverting ileostomy and surgical technique (c-index = 0.71). The prediction model for postoperative day 2 only included CRP (c-index = 0.69). The prediction model for postoperative day 3 included CRP and MMP9 and obtained the best model performance (c-index = 0.78). CONCLUSION The combination of serum CRP and peritoneal MMP9 may be useful for earlier prediction of AL after rectal cancer resection. In clinical practice, this combination of biomarkers should be interpreted in the clinical context as with any other diagnostic tool.
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Affiliation(s)
- C. L. Sparreboom
- Department of SurgeryErasmus MC – University Medical CentreRotterdamThe Netherlands
| | - N. Komen
- Department of Abdominal SurgeryUniversity Hospital AntwerpUniversity of AntwerpEdegemBelgium
| | - D. Rizopoulos
- Department of BiostatisticsErasmus MC – University Medical CenterRotterdamThe Netherlands
| | - A. P. Verhaar
- Department of Gastroenterology and HepatologyErasmus MC – University Medical CenterRotterdamThe Netherlands
| | - W. A. Dik
- Department of ImmunologyLaboratory Medical ImmunologyErasmus MC – University Medical CenterRotterdamThe Netherlands
| | - Z. Wu
- Department of SurgeryErasmus MC – University Medical CentreRotterdamThe Netherlands
| | | | - P. G. Doornebosch
- Department of SurgeryIJsselland ZiekenhuisCapelle aan den IjsselThe Netherlands
| | - J. W. T. Dekker
- Department of SurgeryReinier de Graaf GasthuisDelftThe Netherlands
| | - A. G. Menon
- Department of SurgeryIJsselland ZiekenhuisCapelle aan den IjsselThe Netherlands,Department of SurgeryHavenziekenhuisRotterdamThe Netherlands
| | - F. Daams
- Department of SurgeryVU University Medical CenterAmsterdamThe Netherlands
| | - D. Lips
- Department of SurgeryJeroen Bosch ZiekenhuisHertogenboschThe Netherlands
| | | | - T. M. Karsten
- Department of SurgeryOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands
| | - Y. Bayon
- Sofradim Production, A Medtronic CompanyTrévouxFrance
| | - M. P. Peppelenbosch
- Department of Gastroenterology and HepatologyErasmus MC – University Medical CenterRotterdamThe Netherlands
| | - A. M. Wolthuis
- Department of Abdominal SurgeryUniversity Hospital LeuvenLeuvenBelgium
| | - A. D'Hoore
- Department of Abdominal SurgeryUniversity Hospital LeuvenLeuvenBelgium
| | - J. F. Lange
- Department of SurgeryErasmus MC – University Medical CentreRotterdamThe Netherlands
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47
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Klupp F, Schuler S, Kahlert C, Halama N, Franz C, Mayer P, Schmidt T, Ulrich A. Evaluation of the inflammatory markers CCL8, CXCL5, and LIF in patients with anastomotic leakage after colorectal cancer surgery. Int J Colorectal Dis 2020; 35:1221-1230. [PMID: 32307587 PMCID: PMC7320065 DOI: 10.1007/s00384-020-03582-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Anastomotic leakage constitutes a dreaded complication after colorectal surgery, leading to increased morbidity and mortality as well as prolonged hospitalization. Most leakages become clinically apparent about 8 days after surgery; however, early detection is quintessential to reduce complications and to improve patients' outcome. We therefore investigated the significance of specific protein expression profiles as putative biomarkers, indicating anastomotic leakage. METHODS In this single-center prospective cohort study serum and peritoneal fluid samples-from routinely intraoperatively inserted drainages-of colorectal cancer patients were collected 3 days after colorectal resection. Twenty patients without anastomotic leakage and 18 patients with an anastomotic leakage and without other complications were included. Protein expression of seven inflammatory markers in serum and peritoneal fluid was assessed by multiplex ELISA and correlated with patients' clinical data. RESULTS Monocyte chemoattractant protein 2 (CCL8/MCP-2), leukemia-inhibiting factor (LIF), and epithelial-derived neutrophil-activating protein (CXCL5/ENA-78) were significantly elevated in peritoneal fluid but not in serum samples from patients subsequently developing anastomotic leakage after colorectal surgery. No expressional differences could be found between grade B and grade C anastomotic leakages. CONCLUSION Measurement 3 days after surgery revealed altered protein expression patterns of the inflammatory markers CCL8/MCP2, LIF, and CXCL5/ENA-78 in peritoneal fluid from patients developing anastomotic leakage after colorectal surgery. Further studies with a larger patient cohort with inclusion of different variables are needed to evaluate their potential as predictive biomarkers for anastomotic leakage.
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Affiliation(s)
- F. Klupp
- grid.7700.00000 0001 2190 4373Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - S. Schuler
- grid.7700.00000 0001 2190 4373Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - C. Kahlert
- grid.4488.00000 0001 2111 7257Department of Visceral, Thoracic and Vascular Surgery, University of Dresden, Fetscherstr. 74, 01307 Dresden, Germany
| | - N. Halama
- grid.7700.00000 0001 2190 4373National Center for Tumor Diseases, Medical Oncology and Internal Medicine VI, Tissue Imaging and Analysis Center, Bioquant, University of Heidelberg, Im Neuenheimer Feld 267, 69120 Heidelberg, Germany
| | - C. Franz
- grid.7700.00000 0001 2190 4373Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - P. Mayer
- grid.5253.10000 0001 0328 4908Department of Diagnostic and Interventional Radiology, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - T. Schmidt
- grid.7700.00000 0001 2190 4373Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany
| | - A. Ulrich
- grid.7700.00000 0001 2190 4373Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany ,grid.416164.0Department of General and Visceral Surgery, Lukas Hospital Neuss, Preußenstr. 84, 41464 Neuss, Germany
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48
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Ellebaek MB, Rahr HB, Boye S, Fristrup C, Qvist N. Detection of early anastomotic leakage by intraperitoneal microdialysis after low anterior resection for rectal cancer: a prospective cohort study. Colorectal Dis 2019; 21:1387-1396. [PMID: 31318495 DOI: 10.1111/codi.14781] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/28/2019] [Indexed: 12/31/2022]
Abstract
AIM Anastomotic leakage (AL) is a common and serious complication following sphincter-preserving surgery for rectal cancer. Early detection and intervention can improve clinical outcomes. The aim of this prospective cohort study was to compare intraperitoneal microdialysis with a clinical scoring system for early detection of AL. METHOD A microdialysis catheter was anchored near the anastomosis at low anterior resection (LAR) for rectal cancer. Peritoneal fluid samples were analysed (lactate, pyruvate, glucose and glycerol concentration) 4-hourly and compared with a daily clinical leak score (DULK = Dutch leakage). At day 7 a pelvic CT with rectal contrast enema was performed to establish if there had been a radiological leak. RESULTS In this two-centre study, 129 patients [median age 65 (26-82) years; 60.5% male] underwent LAR. The leak rate was 27% (grade A, n = 11; grade B, n = 12; grade C, n = 12). Receiver operator characteristic analysis demonstrated a lactate cut-off value of 9.8 mm and had 77% sensitivity, 82% specificity, 78% accuracy, a positive predictive value (PPV) of 58, a negative predictive value (NPV) of 88 (CI 79-94) and an area under the curve (AUC) of 0.9 for AL. This compared with a clinical score ≥ 4, which had 57% sensitivity, 79% specificity, 71% accuracy, a PPV of 46, a NPV of 82 and an AUC of 0.7 for AL. The mean day for a positive test when using delta lactate ≥ 6.3 mm was 1.6 days and for leak score ≥ 4 it was 3.3 days (NS). CONCLUSION When AL occurs, intraperitoneal lactate concentration increases over time, and at a certain cut-off has a higher sensitivity, specificity, accuracy, PPV and NPV than a clinical scoring system.
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Affiliation(s)
- M B Ellebaek
- Department of Surgery, Odense University Hospital, Odense, Denmark.,OPEN, Odense Patient data Explorative Network, Odense, Denmark
| | - H B Rahr
- Department of Surgery, Vejle Hospital, Vejle, Denmark
| | - S Boye
- Department of Radiology, Svendborg Hospital, Svendborg, Denmark
| | - C Fristrup
- Department of Surgery, Odense University Hospital, Odense, Denmark
| | - N Qvist
- Department of Surgery, Odense University Hospital, Odense, Denmark
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49
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Su'a B, Tutone S, MacFater W, Barazanchi A, Xia W, Zeng I, Hill AG. Diagnostic accuracy of procalcitonin for the early diagnosis of anastomotic leakage after colorectal surgery: a meta‐analysis. ANZ J Surg 2019; 90:675-680. [DOI: 10.1111/ans.15291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 01/06/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Bruce Su'a
- Department of SurgerySouth Auckland Clinical Campus, Middlemore Hospital, The University of Auckland Auckland New Zealand
| | - Senitila Tutone
- Department of SurgerySouth Auckland Clinical Campus, Middlemore Hospital, The University of Auckland Auckland New Zealand
| | - Wiremu MacFater
- Department of SurgerySouth Auckland Clinical Campus, Middlemore Hospital, The University of Auckland Auckland New Zealand
| | - Ahmed Barazanchi
- Department of SurgerySouth Auckland Clinical Campus, Middlemore Hospital, The University of Auckland Auckland New Zealand
| | - Weisi Xia
- Department of SurgerySouth Auckland Clinical Campus, Middlemore Hospital, The University of Auckland Auckland New Zealand
| | - Irene Zeng
- Department of SurgeryThe University of Auckland Auckland New Zealand
| | - Andrew G. Hill
- Department of SurgerySouth Auckland Clinical Campus, Middlemore Hospital, The University of Auckland Auckland New Zealand
- Department of General SurgeryMiddlemore Hospital, Counties‐Manukau District Health Board Auckland New Zealand
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50
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Hain E, Maggiori L, Laforest A, Frontali A, Prost à la Denise J, Panis Y. Hospital stay for temporary stoma closure is shortened by C-reactive protein monitoring: a prospective case-matched study. Tech Coloproctol 2019; 23:453-459. [DOI: 10.1007/s10151-019-02003-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/13/2019] [Indexed: 01/14/2023]
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