Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

Чернышов, С. В.; Alexeev, Mikhail; Rybakov, E. G.; Tarasov, Mikhail; Shelygin, Yuri; Зароднюк, И. В.; Сухина, М. А.

doi:10.5604/01.3001.0011.8169

Cited by 12 publications

(8 citation statements)

References 27 publications

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“…Our study is the first study evaluating the role of serum markers in the early detection of AL after gyneoncological operations. There have been many studies showing the possible role of serum PCT and CRP in the diagnosis of AL after elective colorectal surgeries 6 . In the study of Alvara Garcia-Granero et al, in case of major AL, PCT and CRP were proved as reliable predictors on POD 3 to 5 with the best value for PCT on POD 5 was 0.31 ng/ml (AUC = 0.86) (Sensitivity = 100%, specifity = 72%, positive predictive value = 17%, negative predictive value = 100%) 7 .…”

Section: Discussionmentioning

confidence: 99%

Serum markers for the early diagnosis of intestinal anastomotic leak after gyne-oncological operations

kuru¹,

cakir²,

akgör³

et al. 2021

Preprint

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Objective: To analyze the serum markers for the early diagnosis of intestinal anastomotic leak (AL) after the gyne-oncological operations. Methods: Between September 2017 and March 2021, patients with an intestinal anastomosis performed during the gyne-oncological surgeries were identified from a tertiary center in Turkey. As the local guideline of the clinic, all these patients were followed by measuring serum samples including procalcitonin (PCT) and C-reactive protein (CRP) on postoperative day (POD) 1 through the day of discharge or the day of re-operation for AL. Results: 12.5% (5/40) of the patients suffered an AL and 4 of them were re-operated. The mean albumin values on POD 3-4 and the mean platelet values on POD 1 were lower in the AL group (p<0.05). Although it was not statistically significant (p>0.05), median PCT values (ng/mL) on POD 8-10 were higher in the AL group compared with no leak group. The best cutt-off point for PCT on POD 9 was determined to be 0.11 ng/mL (AUC: 0.917, Sensitivity = %100.0, specifity = %66.7, positive predictive value = %66.7, negative predictive value = %100.0). Conclusion: Serum PCT and CRP concentrations were not found to be helpfull for the early diagnosis of AL in patients operated for gyne-oncological malignancies. Low levels of albumin and platelets in the first days after the operation may be clue for a possible AL.

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Section: Discussionmentioning

confidence: 99%

Serum markers for the early diagnosis of intestinal anastomotic leak after gyne-oncological operations

kuru¹,

cakir²,

akgör³

et al. 2021

Preprint

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“…Another study supported the assertion that the predictive value of procalcitonin for ALs was improved when combined with CRP and WBC count [ 203 ]. At the same time, other researchers revealed high NPVs of CRP and procalcitonin for anastomotic failure in the early postoperative period [ 204 ].…”

Section: Diagnostic Workupmentioning

confidence: 99%

Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?

et al. 2023

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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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“…CRP levels were found to be high on POD-3 and POD-6. From this, we can conclude that the high CRP and PCT levels had high negative predictions on both days [ 21 ].…”

Section: Reviewmentioning

confidence: 99%

Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review

Selvamani¹,

Shoukrie²,

Malla³

et al. 2022

Cureus

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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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Risk factors and inflammatory predictors for Anastomotic Leakage following Total Mesorectal Excision with defunctioning stoma

Abstract: Following low restorative proctectomy, the high NPV of CRP and PCT measurements for the diagnosis of anastomotic leaks may assist decision-making for early hospital discharge.

Cited by 12 publications

References 27 publications

Serum markers for the early diagnosis of intestinal anastomotic leak after gyne-oncological operations

Serum markers for the early diagnosis of intestinal anastomotic leak after gyne-oncological operations

Predictive Factors for Anastomotic Leakage Following Colorectal Cancer Surgery: Where Are We and Where Are We Going?

Predictors That Identify Complications Such As Anastomotic Leak in Colorectal Surgery: A Systematic Review

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