Metabolism, inflammation and postoperative time are the key to early diagnosis of anastomotic leak

• Objective: The aim of the study was to find laboratory samples for early diagnosis of anastomotic leak.Summary background data: Anastomotic leakage after rectal cancer surgery is a severe complication with high mortality. Outcome is highly dependent on early diagnosis.Methods: 29 patients were investigated postoperatively after having undergone low anterior resection due to cancer recti. Patient outcomes were divided into three groups: Anastomotic leak in 7 patients, other complications in 9 patients and 13 patients who were free of complications. Patients were monitored every 6th hour with blood and intraperitoneal samples in order to identify laboratory markers for early detection of anastomotic leakage. An anastomotic leak index was created, a scoring system where points count for values higher than reference values of CRP and interleukin 6 in blood and intraperitoneal lactate, lactate/pyruvate ratio and interleukin 6 were measured at 18, 24, 42 and 48 hours postoperatively.Results: Significant differences between groups were found regarding CRP, Interleukin 6, fibrinogen and D-dimer in blood. Intraperitoneal differences were found not only in lactate and lactate/pyruvate ratio measured by microdialysis, significant differences in interleukin 6, interleukin 10 and tumour necrosis factor-α could also be demonstrated between the groups. The anastomotic leak index had a sensitivity and specificity of 86% (p=0.0007).Conclusions: The most important factor was time after operation. No laboratory parameter in itself could predict an anastomotic leak but the anastomotic leak index was a useful tool in the monitoring and assessment of clinical outcome.Mini abstract: Patients with anastomotic leak after rectal surgery were monitored with higher intraperitoneal cytokines and lactate/pyruvate ratio. The results suggest intraperitoneal microdialysis combined with blood samples of CRP and IL 6 as a feasible method for early diagnosis of anastomotic leak.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kirurgi (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Surgery (hsv//eng)

Nyckelord

Rectal surgery

Anastomotic leak

Intraperitoneal microdialysis

Lactate pyruvate ratio

Intraperitoneal cytokines

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)