Acidic Pelvic Drainage as a Predictive Factor For Anastomotic Leakage after Surgery for Patients with Rectal Cancer

Abstract

considerable extra cost, increased in-hospital morbidity and mortality, impaired pelvic organ function (Eriksen et al., 2005; Law et al., 2007; Lee et al., 2008;Riss et al., 2011). Although there are multiple risk factors, such as being male, advanced age, severe obesity, lower tumor site (less than 4cm from the anal verge) and the reduction of TSGF in POD5, which are associated with anastomotic leakage have been reported in our previous study (Yang in individual patients on account of the absence of a early stage.The diagnosis of AL should be as early as possible for the sake of reducing its associated morbidity and mortality (Doeksen et al., 2007). Many studies on anterior resections regarding AL come from multi-center and different surgeons. A variety of factors predisposing to AL have been reported in the previous investigations. However, lack of data about the risk factors and incidence associated with AL from a single-institute of one team of doctors. Liu Yang et al 5442In addition, a great deal previous studies are repetitive works and duplicated effforts because of the limited power of innovative thinking. The pathophysiological processes and considering that interstitial acidic pH notion that extracellular acidosis may intensify the acute and extending its functional lifespan (Trevani et al., 1999; Martínez et al., 2006). The acidic microenvironments developing and the pelvic draining is becoming acidic, which is the main theoretical foundation for the present research. This study aimed to evaluate the utility of sequential postoperative pelvic drainage determinations of of AL after anterior resection of rectal cancer, which has not been reported ever before. Materials and MethodsBetween January 2004 and December 2011, 753 consecutive patients with rectal cancer underwent anterior resection with double stapling anastomosis for primary Jiangsu Cancer Hospital of Nanjing Medical University & Jiangsu Institute of Cancer Research, Nanjing, China. The medical notes of all patients were reviewed in detail.of TNM stage, histologically proven adenocarcinoma, open and laparoscopic surgery with pelvic drainage, all patients with 12 postoperative determinations of pH value, and antibiotics using for 7 PODs. Exclusion criteria were of TNM stage, colon cancer, hand-sewn anastomosis and perioperatively abdominopelvic implants that might be affect pH value, ongoing infection before surgery or an acquired infection in the postoperative period other the distance from the anal verge, as determined by rigid sigmoidoscopy. Total mesorectal excision was adopted as the standard surgical technique according to tumor location. The Ethics Committee of Science approved data collection in the register.All the patients were assigned to one of two groups according to the presence or absence of AL: with AL (Group AL, n=57), without AL (Group nAL, n=696). The two groups were compared according to the following characteristics: median age, gender, physical status (ASA score), the alcohol and tobacco abuse, tumor site, TNM stage, pre...

Evaluation of Stapled versus Hand-Sewn Techniques for Colo-Rectal Anastomosis after Low Anterior Resection of Mid-Rectal Carcinoma: a Study on 50 Patients

“…In a study by Yang et al, 2013 they reported an AL of 7.6%, inspite that this rate seems lower than in this study, however they included the whole rectum (including upper rectum), they excluded hand-sewn anastomoses and an acquired infection in the postoperative period other than leakage. Yang et al (2014) demonstrated an anastomotic leakage in anterior resection with a double stapling technique of 7.6% between the 6 th and 12 th postoperative days compared to 12% in the stapled group of this study, and this difference may be due the small sample size (n=25) in this study compared to (n=753), while leakage in this study was diagnosed between the 6 th and 8 th postoperative days.…”

“…Dusky, cyanosed, bowel ends indicate an inadequate arterial supply and the affected Segment important for anastomosis and stoma formation involving the large bowel (Joyce et al, 2002;Goulder et al, 2012). In this study, all the preceding factors for anastomotic integrity were considered and applied by the surgeon intra-operatively, and since irradiated bowel or previous chemotherapy are contributing factors in anastomotic failure and leakage (Trencheva et al, 2013;Yang et al, 2013), all patients in this study didn't receive neoadjuvant chemoradiation regarding the early stage (T2) and relatively the high distance from the anal verge 9.6±2.0 cm in group I and 9.9±2.4 cm in group II.…”

Systematic review of the role of biomarkers in diagnosing anastomotic leakage following colorectal surgery

“…Six studies 16,24,30,31,35,49 evaluated peritoneal and systemic biomarkers of ischaemia in the context of AL following colorectal surgery. Matthiessen and colleagues 31 reported a statistically significant increase in the lactate/pyruvate (L/P) ratio on POD 5 and 6 in four patients with AL diagnosed up to POD 14 (median POD 6), and another three with AL diagnosed after discharge (median POD 20, range [18][19][20][21][22].…”

The value of biomarkers in early diagnosis of anastomotic leak following colorectal tumor resection: a review of the literature between 2012 and 2017

“…a daily rise of around 50 units being most predictive Burke, 2017, [17] CRP (POD5, cutoff value:132 mg/l), CRP (sensitivity 70%, specilficity 76.6%), Ismail, 2017, [18] Serum CRP and PCT (POD3), Drain TNF-a and bacterial proliferation (POD5) Komen, 2014, [19] LBP An increase in the average initial value at the first postoperative day with 1 standard deviation increased the risk of leakage by 1.6 times. Urszula, 2016, [21] PCT (POD1, cutoff value:1.09 ng/mL) Sensitivity 87%, specilficity 87% Tarik, 2016, [22] Peritoneal IL-6 (POD1, cutoff value:3091 pg/ml); peritoneal IL-10 (POD1, cutoff value:504 pg/ml) Peritoneal IL-6 (sensitivity 86%, specilficity 52%), peritoneal IL-10 (sensitivity 86%, specilficity 62%) Elyamani, 2011, [23] Cytokines (IL-6, IL-10, TNF), microbiological study (Escherichia coli, Klebsiella, Pseudomonas species, and bacteriod microorganism) Käser, 2014, [25] Hyponatremia Sensitivity 23%, specilficity 93% Liu, 2013, [26] PH: POD3, cutoff value: 6.978 Sensitivity 98.7%, specilficity 94.7% Liron, 2016, [27] CEA (1000 ng/mL) drainage fluid after rectal surgery with anastomosis, is a marker of AL. A cut-off value of 6.978 determined at 25°C on POD3 maximizes the sensitivity and specificity [26].…”

“…Urszula, 2016, [21] PCT (POD1, cutoff value:1.09 ng/mL) Sensitivity 87%, specilficity 87% Tarik, 2016, [22] Peritoneal IL-6 (POD1, cutoff value:3091 pg/ml); peritoneal IL-10 (POD1, cutoff value:504 pg/ml) Peritoneal IL-6 (sensitivity 86%, specilficity 52%), peritoneal IL-10 (sensitivity 86%, specilficity 62%) Elyamani, 2011, [23] Cytokines (IL-6, IL-10, TNF), microbiological study (Escherichia coli, Klebsiella, Pseudomonas species, and bacteriod microorganism) Käser, 2014, [25] Hyponatremia Sensitivity 23%, specilficity 93% Liu, 2013, [26] PH: POD3, cutoff value: 6.978 Sensitivity 98.7%, specilficity 94.7% Liron, 2016, [27] CEA (1000 ng/mL) drainage fluid after rectal surgery with anastomosis, is a marker of AL. A cut-off value of 6.978 determined at 25°C on POD3 maximizes the sensitivity and specificity [26]. Evidences showed that carcinoembryonic antigen (CEA) elevation were associated with the inflammation process that accompanies AL [19].…”