Predictive Factors for Anastomotic Leakage After Colorectal Surgery: Study Protocol for a Prospective Observational Study (REVEAL Study)

Jongen, Audrey C. H. M.; Bosmans, Joanna W. A. M.; Kartal, Serdar; Lubbers, Tim; Sosef, Meindert N.; Slooter, Gerrit D.; Stoot, Jan H.M.B.; Schooten, Frederik‐Jan van; Bouvy, Nicole D.; Derikx, Joep P. M.

doi:10.2196/resprot.5477

Cited by 10 publications

(6 citation statements)

References 55 publications

(61 reference statements)

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“…This study was approved by the Medical Ethical Committee of Maastricht University Medical Center and conducted according to the Declaration of Helsinki (October 2013, Fortaleza). Included patients were part of the REVEAL study [22], which is registered at clinicaltrials.gov (NCT02347735).…”

Section: Methodsmentioning

confidence: 99%

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

et al. 2019

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ObjectiveNear-infrared fluorescence (NIRF) imaging using indocyanine green (ICG) might help reduce anastomotic leakage (AL) after colorectal surgery. This pilot study aims to analyze whether a relation exists between measured fluorescence intensity (FI) and postoperative inflammatory markers of AL, C-reactive protein (CRP), Intestinal fatty-acid binding protein (I-FABP), and calprotectin, to AL, in order to evaluate the potential of FI to objectively predict AL.MethodsPatients scheduled for anastomotic colorectal cancer surgery were eligible for inclusion in this prospective pilot study. During surgery, at three time points (after bowel devascularization; before actual transection; after completion of anastomosis) a bolus of 0.2 mg/kg ICG was administered intravenously for assessment of bowel perfusion. FI was scored in scale from 1 to 5 based on the operating surgeon’s judgment (1 = no fluorescence visible, 5 = maximum fluorescent signal). The complete surgical procedure was digitally recorded. These recordings were used to measure FI postoperatively using OsiriX imaging software. Serum CRP, I-FABP, and calprotectin values were determined before surgery and on day 1, 3, and 5 postoperative; furthermore, the occurrence of AL was recorded.ResultsThirty patients (n = 19 males; mean age 67 years; mean BMI 27.2) undergoing either laparoscopic or robotic anastomotic colorectal surgery were included. Indication for surgery was rectal—(n = 10), rectosigmoid—(n = 2), sigmoid—(n = 10), or more proximal colon carcinomas (n = 8). Five patients (16.7%) developed AL (n = 2 (6.6%) grade C according to the definition of the International Study group of Rectal Cancer). In patients with AL, the maximum fluorescence score was given less often (P = 0.02) and a lower FI compared to background FI was measured at 1st assessment (P = 0.039). However, no relation between FI and postoperative inflammatory parameters could be found.ConclusionBoth subjective and measured FI seem to be related to AL. In this study, no relation between FI and inflammatory serum markers could yet be found.

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Section: Methodsmentioning

confidence: 99%

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

et al. 2019

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“…Equally, emergency surgical procedures are burdened by increased risk of leakage (7). The distance between anastomosis and anal verge seems to have an inverse relationship with leakage rate: the higher the distance the more frequent the leakage.…”

Section: Abstract Background/aim: a Protective Ileostomy Performed Dmentioning

confidence: 98%

Anastomotic Leakage in Rectal Surgery: Role of the Ghost Ileostomy

et al. 2019

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“…Anastomotic leak (AL) is one of the most feared complications of gastrointestinal (GI) surgery. With rates ranging between 2% and 15%, AL is associated with high morbidity and mortality [1][2][3][4][5][6][7]. There is no specific method to prevent or to predict an AL.…”

Section: Introductionmentioning

confidence: 99%

Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients

Slavin

Goldstein

Raguan

et al. 2022

JPM

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Background: In colorectal cancer, C-reactive protein (CRP) levels on postoperative days 3–4 have a strong negative predictive value for an anastomotic leak, with threshold values of ~15 on post-operative day (POD) 3 and ~13 on POD 4. In Crohn’s disease, CRP levels are perceived as unreliable in the postoperative period because of the underlying inflammatory process. The aim of this study was to determine whether postoperative CRP levels can be used to rule out anastomotic leaks in patients with Crohn’s disease and to set CRP threshold values for this population. Methods: This was a retrospective study of a population of Crohn’s disease patients who underwent surgery with bowel anastomoses at a single high-volume center between 1/2012 and 12/2017. The operations were performed by a single colorectal consultant who is an inflammatory bowel disease specialist. Results: Ninety-two operations were performed. A CRP level of 19.56 mg/dL on postoperative day 3 had an area under the curve of 0.865 (sensitivity 88%, specificity 73%) and a negative predictive value (NPV) of 98% for an anastomotic leak. Patients with an anastomotic leak showed a trend towards decreased postoperative albumin levels (p = 0.06). Conclusions: Mean CRP levels and CRP threshold values were indeed higher in the study population compared with those in colorectal cancer patients. Threshold values were set at 20.3 mg/dL on POD 3, 19.5 mg/dL on POD 4 and 16.7 mg/dL on POD 5. These values had high NPVs and can be used to rule out anastomotic leaks in patients with Crohn’s disease after surgery with bowel anastomosis.

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Predictive Factors for Anastomotic Leakage After Colorectal Surgery: Study Protocol for a Prospective Observational Study (REVEAL Study)

Cited by 10 publications

References 55 publications

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

Near-infrared fluorescence image-guidance in anastomotic colorectal cancer surgery and its relation to serum markers of anastomotic leakage: a clinical pilot study

Anastomotic Leakage in Rectal Surgery: Role of the Ghost Ileostomy

Postoperative CRP Levels Can Rule out Anastomotic Leaks in Crohn’s Disease Patients

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