DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20202896

Role of biomarkers in predicting anastomotic leakage following colorectal surgeries

Mumtaz Din Wani, Ferkhand Mohi Ud Din, Aabid Rasool Bhat, Irshad Ahmad Kumar, Ashiq Hussain Raina, Zubair Gul

Abstract


Background: Recovery after surgery for patients with colorectal disease has improved with the advent of minimal access surgery and standardized recovery protocols. Despite these advances, anastomotic leakage remains one of the most dreaded complications following colorectal surgery, with rates of 3-27 per cent depending on specific risk factors. The aim of the study was to assess sensitivity and specificity of systemic and peritoneal drain-fluid bio-markers in early prediction of anastomotic leak; and to co-relate rise in levels of biomarkers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.

Methods: The present study was a prospective observational study conducted on 60 patients in the Postgraduate Department of Surgery, Government Medical College, Srinagar after obtaining due ethical clearance over a period of two years.

Results: The mean age was 54.87±11.901 years with 44 patients (73.3%) were males. Among systemic makers: the mean CRP level was 2.7800±0.500 mg/L, the mean total leukocyte count was 10.783±0.940 thousands and the mean serum procalcitonin level was 0.365±0.1385 ng/ml. Among peritoneal fluid drain bio-makers, the mean IL-6 level was 3551.066±1311.965 pg/ml, the mean IL-10 level was 628.533±460.358 pg/ml and the mean TNF-a level was 16.391±6.736 pg/ml. The anastomotic leak after colo-rectal surgery was noted in 16 patients (26.7%). In our study significant co-relation was noted between the rise in levels of peritoneal drain fluid biomarkers and severity of clinical symptoms but no significant co-relation was noted between the rise in levels of systemic markers and severity of clinical symptoms in patients who have undergone colo-rectal surgeries.

Conclusions: Systemic biomarkers are poor predictors of anastomotic leak after colorectal surgery. But sensitivity and specificity of peritoneal fluid drain biomarkers in predicting anastomotic leak was significantly high.


Keywords


Anastomotic leak, Biomarker, CRP, IL-6, IL-10, Procalcitonin, TNF-α, TLC

Full Text:

PDF

References


Sammour T, Zargar-Shoshtari K, Bhat A, Kahokehr A, Hill AG. A programme of Enhanced Recovery After Surgery (ERAS) is a cost-effective intervention in elective colonic surgery. N Z Med J. 2010;123:61-70.

Matthiessen P, Henriksson M, Hallbook O, Grunditz E, Noren B, Arbman G. Increase of serum C-reactive protein is an early indicator of subsequent symptomatic anastomotic leakage after anterior resection. Colorectal Dis. 2008;10:75-80.

Iancu C, Mocan LC, Todea-Iancu D, Mocan T, Acalovschi I, Ionescu D, et al. Host-related predictive factors for anastomotic leakage following large bowel resections for colorectal cancer. J Gastrointest Liver Dis. 2008;17:299-303.

McDermott FD, Heeney A, Kelly ME, Steele RJ, Carlson GL, Winter DC. Systematic review of preoperative, intraoperative and postoperative risk factors for colorectal anastomotic leaks. Br J Surg. 2015;102:462-79.

Ashburn JH, Stocchi L, Kiran RP, Dietz DW, Remzi FH. Consequences of anastomotic leak after restorative proctectomy for cancer: effect on long-term function and quality of life. Dis Colon Rectum. 2013;56:275-80.

Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB, Hill AG. Systematic review and meta-analysis of use of serum C-reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101:339-46.

Hyman N, Manchester TL, Osler T, Burns B, Cataldo PA. Anastomotic leaks after intestinal anastomosis: it’s later than you think. Ann Surg. 2007;245:254-8.

Lagoutte N, Facy O, Ravoire A, Chalumeau C, Jonval L, Rat P, et al. C-reactive protein and procalcitonin for the early detection of anastomotic leakage after elective colorectal surgery: pilot study in 100 patients. J Visc Surg. 2012;149:345-9.

Dulk M, Witvliet MJ, Kortram K, Neijenhuis PA, Hingh IH, Engel AF, et al. The DULK (Dutch Leakage Score) and modified DULK score compared: Actively seen the leakage. Colorectal Dis. 2013 Sep;15(9):e528-33.

Pasternak B, Matthiessen P, Jansson K, Andersson M, Aspenberg P. Elevated intraperitoneal matrix metalloproteinases-8 and -9 in patients who develop anastomotic leakage after rectal cancer surgery: a pilot study. Colorectal Dis. 2010;12:93-8.

Daams F, Luyer M, Lange JF. Colorectal anastomotic leakage: Aspects of prevention, detection and treatment. World J Gastroenterol. 2013 Apr;19(15):2293-7.

Giaccaglia V, Salvi PF, Cunsolo GV, Sparagna A, Antonelli MS, Nigri G, et al. Procalcitonin, as an early biomarker of colorectal anastomotic leak, facilitates enhanced recovery after surgery. J Crit Care. 2014 Aug;29(4):528-32.

Su'a BU, Mikaere HL, Rahiri JL, Bissett IB, Hill AG. Systematic review of the role of biomarkers in diagnosing anastomotic leakage following colorectal surgery. Br J Surg. 2017 Apr;104(5):503-12.

Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy J Gastrointest Surg. 2007;11:8-15.

Slieker JC, Komen N, Mannaerts GH, Karsten TM, Willemsen P, Murawska M, et al. Long-term and perioperative corticosteroids in anastomotic leakage: a prospective study of 259 left-sided colorectal anastomoses. Arch. Surg. 2012;147:447-52.

Huh JW, Kim HR, Kim YJ. Anastomotic leakage after laparoscopic resection of rectal cancer: the impact of fibrin glue. Am J Surg. 2010;199:435-41.

den Dulk M, Noter SL, Hendriks ER, Brouwers MA, van der Vlies CH, Oostenbroek RJ, et al. Improved diagnosis and treatment of anastomotic leakage after colorectal surgery. Eur J Surg Oncol. 2009;35:420-6.

Doeksen A, Tanis PJ, Vrouenraets BC, Lanschot van JJ, Tets van WF. Factors determining delay in relaparotomy for anastomotic leakage after colorectal resection. World J Gastroenterol. 2007;13:3721-5.

Warschkow R, Beutner U, Steffen T, Müller SA, Schmied BM. Safe and early discharge after colorectal surgery due to C-reactive protein: a diagnostic meta-analysis of 1832 patients. Ann Surg. 2012;256:245-50.

Woeste G, Müller C, Bechstein WO, Wullstein C. Increased serum levels of C-reactive protein precede anastomotic leakage in colorectal surgery. World J Surg. 2010;34:140-6.

Singh PP, Zeng IS, Srinivasa S, Lemanu DP, Connolly AB. Systematic review and meta-analysis of use of serum C- reactive protein levels to predict anastomotic leak after colorectal surgery. Br J Surg. 2014;101:339-46.

Garcia-Granero A, Frasson M, Flor-Lorente B, Blanco F, Puga R. Procalcitonin and C-reactive protein as early predictors of anastomotic leak in colorectal surgery: a prospective observational study. Dis Colon Rectum. 2013;56:475-83.

Giaccaglia V, Salvi PF, Antonelli MS, Nigri G, Pirozzi F. Procalcitonin reveals early dehiscence in colorectal surgery: The PREDICS study. Ann Surg. 2013;263:967-72.

Komen N, Slieker J, Willemsen P, Mannaerts G, Pattyn P, Karsten T, et al. Polymerase chain reaction for Enterococcus faecalis in drain fluid: the first screening test for symptomatic colorectal anastomotic leakage. The Appeal-study: analysis of parameters predictive for evident anastomotic leakage. Inter J Colorectal Dis. 2014 Jan 1;29(1):15-21.

Sammour T, Singh PP, Zargar-Shoshtari K, Su’a B, Hill AG. Peritoneal Cytokine Levels Can Predict Anastomotic Leak on the First Postoperative Day. Dis Colon Rectum. 2016 Jun 1;59(6):551-6.