Is Early Detection of Anastomotic Leakage Possible by Intraperitoneal Microdialysis and Intraperitoneal Cytokines After Anterior Resection of the Rectum for Cancer?

Matthiessen, Peter; Strand, Ida E U Hall; Jansson, Kjell; Törnquist, Cathrine; Andersson, Magnus; Rutegård, Jörgen; Norgren, Lars

doi:10.1007/s10350-007-9023-4

Cited by 87 publications

(100 citation statements)

References 18 publications

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“…The present issue includes a study by Daams et al [9] on peritoneal microdialysis which shows significant changes in peritoneal lactate concentration in patients with symptomatic AL. Similar results have been demonstrated in other studies [10,11]. However, additional, larger clinical trials are needed to specify the cut-off values for the parameters measured, and investigations of other inflammatory parameters collected with microdialysis must also be evaluated.…”

supporting

confidence: 85%

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

Ellebæk

Qvist

2013

Tech Coloproctol

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Anastomotic leakage (AL) after low anterior resection for rectal cancer is a challenging complication in rectal cancer surgery. The reported frequency is 10-20 % in most publications, irrespective of the creation of a diverting stoma. AL has both immediate and long-term consequences that affect morbidity, mortality, functional and oncological outcome.The oncological impact of AL is still under discussion. Several studies have demonstrated an increase in local recurrence rate and a decreased overall survival, while other studies have failed to demonstrate this connection. A recent study showed that AL, which required reoperation, was associated with a significantly higher local recurrence and lower overall survival rate [1].In most cases, the clinical presentation of AL is insidious with vague and uncharacteristic abdominal symptoms, which may be masked by the use of epidural analgesia. Some cases may present with extraintestinal manifestations such as atrial fibrillation or mental confusion. Thus, AL is typically not recognized until postoperative day 5-7, which in many cases means there is significant delay in diagnosis. Another explanation of delayed diagnosis might be the low diagnostic sensitivity and specificity of common clinical tests such as body temperature, C-reactive protein (CRP) concentration and leukocyte count in peripheral blood, which moreover may be obscured by other inflammatory conditions such as pneumonia, urinary tract infections and surgical site infections. The same may apply to other inflammatory parameters such as cytokines. A recent pilot study conducted by our group using a panel of 10 cytokines and 2 complement factors in patients with and without AL found that only combined changes in IL-4, IL-6 and IL-10 could accurately predict leak (submitted for publication). A study on postoperative CRP in elective abdominal surgery, published in the present issue, showed that patients with CRP \ 135 mg/L on postoperative day 3 were unlikely to develop AL. However, the sensitivity and specificity for AL of elevated values were dependent upon the duration of the elevation in the CRP concentration [2]. Regular computed tomography (CT) scan and endoscopy are other possible but less attractive investigations due to irradiation and the risk of iatrogenic anastomotic dehiscence.Early diagnosis of AL is important to reduce the negative effects on the patient's health and to increase the success rate of treatment without reoperation. Therefore, new tests for early diagnosis of AL, before the development of overt symptoms, are warranted. The problem is that the complete pathophysiological background of AL is unknown. Several factors such as ischemia, inflammation, surgical techniques, comorbidity and preoperative radiochemotherapy may be involved.It is well documented that a diverting loop ileostomy reduces the risk of serious complications due to AL such as fecal peritonitis, reoperation, prolonged morbidity, permanent stoma and death. However, a diverting loop ileostomy is not without consequences and...

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supporting

confidence: 85%

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

Ellebæk

Qvist

2013

Tech Coloproctol

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“…[15] The detection of cytokines through intraperitoneal microdialysis has also been implicated as a tool for detection of anastomotic leakage prior to the emerging of clinical symptoms. [16] However, none of the methods have been proven effective and accepted universally.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, there are some clinical studies attempting to use peritoneal fluid to detect anastomotic leakages earlier than the clinical symptoms. Matthiessen et al [16] have collected intraperitoneal cytokines, IL-6, IL-10, and TNF-alfa through a pelvic drain from patients who underwent anterior resection for rectal cancer. They have concluded that through intraperitoneal monitoring of cytokines anastomotic leakage might be detected before clinical symptoms are manifested.…”

Section: Discussionmentioning

confidence: 99%

The fate of suboptimal anastomosis after colon resection: an experimental study

Yıldız

Okan

Nazik

et al. 2014

Ulus Travma Acil Cerrahi Derg

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“…In a medical trial for defunction stoma procedure, where patients were randomised, results showed that showed that defunctioning loop stoma decreased the probability of anastomosis leak (139). Another study distinguished a higher lactate/pyruvate ratio postoperatively in patients presenting anastomosis leakage before evidences of clinical symptom compared with those without (140).…”

Section: Off-line Microdialysismentioning

confidence: 99%

Microdialysis Monitoring of Biomarkers for Early Recognition of Intestinal Ischemia

Priya¹,

Córcoles²

2012

Sepsis - An Ongoing and Significant Challenge

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Is Early Detection of Anastomotic Leakage Possible by Intraperitoneal Microdialysis and Intraperitoneal Cytokines After Anterior Resection of the Rectum for Cancer?

Abstract: The intraperitoneal lactate/pyruvate ratio and cytokines, IL-6, IL-10, and TNF-alpha, were increased in patients who developed symptomatic anastomotic leakage before clinical symptoms were evident.

Cited by 87 publications

References 18 publications

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

Early detection and the prevention of serious complications of anastomotic leakage in rectal cancer surgery

The fate of suboptimal anastomosis after colon resection: an experimental study

Microdialysis Monitoring of Biomarkers for Early Recognition of Intestinal Ischemia

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