An umbrella systematic review of drain fluid analysis in colorectal surgery for the detection of anastomotic leak: Not yet ready to translate research studies into clinical practice

Abstract

Anastomotic leak (AL) is the anathema of colorectal surgery.Patients who experience an AL have higher morbidity, mortality and poorer long-term oncological outcomes. The reported incidence of AL varies considerably and is estimated between 2.4% and 27% [1-4], and mortality rates as a consequence of sepsis and multiorgan failure are around 15%. Delay in diagnosis and definitive management of sepsis has a measurable effect on mortality [5]. Current approaches to early detection of AL are

Surgical management and long‐term functional outcomes after anastomotic leak in patients undergoing minimally invasive restorative rectal resection and without a diverting ileostomy

“…It may be that a minimally invasive rectal resection facilitates early detection of AL as any deviation from the normal recovery is suspicious for an AL. Early detection of AL may be augmented by drain fluid analysis, with a recent review suggesting that biomarkers may serve as an adjunct to improve the predictive accuracy of clinical diagnosis and the differentiation of other infective complications 1 . In this minimally invasive cohort post‐operative length of stay for both leak and non‐leak patients were less than half that reported in patients undergoing an open resection.…”

“…Anastomotic leak (AL) is the anathema of colorectal surgery. Patients who experience AL have a prolonged hospital stay and increased morbidity and mortality 1 . In cohorts of open operations and those administered neo‐adjuvant cancer therapy, AL has a negative impact on both long‐term oncological and functional outcomes 2 …”

“…Patients who experience AL have a prolonged hospital stay and increased morbidity and mortality. 1 In cohorts of open operations and those administered neo-adjuvant cancer therapy, AL has a negative impact on both long-term oncological and functional outcomes. 2 Ashburn et al studied a large cohort of patients who had undergone rectal cancer surgery as far back as 1980 and assessed their quality of life (QoL) and faecal incontinence severity index (FISI) scores.…”

Multicenter Study of Drain Fluid Amylase as a Biomarker for the Detection of Anastomotic Leakage After Ileal Pouch Surgery Without a Diverting Ileostomy

“…This detail has limited these data from translating into routine clinical practice. 6 In this study, we wished to define a clinically meaningful cutoff threshold and have used the upper limit of the normal serum reference range of amylase (130 U/L).…”

Does an ileostomy cover the surgeon or the anastomosis?

“…The authors found that a new category of BM, the extravasated intra-luminal substances, showed potential for early diagnosis and more neatly married mechanistically with the definition of AL. 13 If a TDI is omitted, is it reasonable to simply return those who do leak to theatre as soon as there is clinical deterioration? This would be the case only if patients can be identified before serious complications set in and if the long-term outcomes are not compromised.…”